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STEP 1 RECALL > Respiratory concepts > Flashcards

Respiratory concepts Flashcards

1
Q

Why is the pO2 in the left atrium lower than in the pulmonary veins (where the blood just came from)?

A

b/c deoxygenated blood originating from the bronchial arteries mixes with the oxy blood (“venous admixture”)

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2
Q

secreted from the lamellar bodies of type 2 pneumocytes

A

Surfactant

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3
Q

the main components of surfactant

A

phosphatidylcholine (Lethicin) & sphingomyelin (L:S ratio > 2 means lungs are mature)

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4
Q

What kind of transmembrane protein is the CFTR protein (responsible for Cystic Fibrosis)

A
  • an ATP-gated ion transporter - pumps Cl- out against a gradient using ATP for energy
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5
Q

Normal arterial blood gas values

A

-pH —> 7.35-7.45 -PaO2—> 80-95 -PaCO2 —> 35-45 -HCO3- —> 22-26

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6
Q

How can you tell an absolute erythrocytosis from a relative erythrocytosis?

(Erythrocytosis/ Polycythemia is defined as HEMATOCRIT > 52% in men and >48% in women)

A

you measure the RBC mass

  • if it is increased, they have an absolute erythrocytosis
  • if it is normal, they have a relative erythrocytosis (ie: relative to decrs in plasma volume)
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7
Q

DIff bwtween Minute Ventilation & Alveolar Ventilation?

A

Dead Space

  • Minute Ventilation = Tidal Volume (L) x breaths/min
  • Alveolar Ventilation = (Tidal volume - dead space) x breaths/min

-Alveolar ventilation only measures the vol of air participating in gas exchange per minute

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8
Q

___________ lung diseases are associated with decreased lung volumes & increased expiratory flow rates (due to decreased lung compliance/ increased recoil and increased radial traction on the airways by the lung)

A

Restrictive diseases (fibrosis)

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9
Q

Heroin overdose causes what kind of metabolic disturbance?

A

-Suppresses respiratory centers and causes hypoventiliation, retaining of CO2 –> Respiratory Acidosis

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10
Q

blood flow (Q) is greatest at the _____ of the lung

A

at the BASE

  • Ventilation (V) is also greatest at the base
  • but the perfusion (Q) is MUCH GREATER than the Ventilation at the base ((so the V/Q ratio is actually lower at the base ))
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11
Q

Where is the correct place to perform a thoracentesis along the midclavicular line, midaxillary and paravertebral line?

A

Midclavicular –> btw ribs 5- 7

Midaxillary –> btw ribs 7-9

Paravertebral –> btw ribs 9-11

  • The pleural border is usually 2 intercostal spaces below the lung border
  • you must go in the space past the lung border but within the pleura.. so you must stay within these rib margins
  • remember: Needle goes on TOP of rib
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12
Q

Fetal lung Lethicin (dipalmitoyl phosphatidylcholine) increases production at ___ weeks gestation

A

increases sharply at 30 weeks

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13
Q

Airway resistance is lowest at the ______________

A

terminal bronchioles (the smallest )

  • Why? – b/c they have the largest total cross sectional area
  • most resistance is in the medium and small sized bronchi
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14
Q

At what point on a spirometry reading is the total pulmonary vascular resistance lowest?

A

at the end of a regular (vital capacity) expiration

  • Not at the end of a forced expiration (b/c then the vessles would be compressed and have higher resistance)
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15
Q

In patients with longstanding COPD, what is their main stimulator of respiratory drive??

  • CO2?
  • O2?
A
  • -Hypoxia (low paO2) sensed at the peripheral chemoreceptors (ie: carotid bodies)* is their only stimulation of resp drive
  • their prolonged hypercapnia has caused CO2 to no longer stimulate the medullay resp center
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16
Q

T or F?

Blood flow per minute is always the same in systemic and pulmonary circulations?

A

TRUE

  • the rate of flow through the lungs must equal the flow rate in systemic circulation at all times ( or else the chambers of the heart wouldn’t fill adequately)
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17
Q

Oxygenated blood from the mother flows into the fetus by the Umbilical __________ –> then to the fetal IVC

A

Umbilical Vein

  • 1 vein (oxy)
  • 2 arteries (deoxy)
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18
Q

What is the main mechanism for clearing small particles (< 2 microns) from the lungs?

A

PHAGOCYTOSIS

  • largest dust particles are sneezed / coughed out
  • particles 10-15 microns are trapped in the UR tract
  • particles 2.5 - 10 microns are cleared by mucociliaryelevator
  • smallest are phagocytized
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19
Q

What is a normal A-a gradient ?

A

Normally the Alveolar -arterial gradient is not more than 10-15 mmHg

(the A-a gradient is the difference btw Alveolar and arterial Oxygen)

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20
Q

dV / dP =

A

**Compliance **

  • volume for a given pressure
  • reduced in Restrictive lung dz
  • increased in Obstructive lung dz
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21
Q

Which lung volume is increased in a person w/ COPD?

A

Residual Volume

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22
Q

What can decrease lung compliance?

A
  • pulmonary fibrosis
  • insufficiant surfactant
  • pulmonary edema / congestion (ie: Left sided heart failure)
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23
Q

which nerve mediates the afferent limb of the cough reflex ?

A

Internal laryngeal nerve

  • located in the pharynx in the piriform recess
  • fish bones stuck in the piriform recess can damage this nerve and affect the cough reflex
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24
Q

High altitude exposure lasting more than a few days results in hypoxemia and a chronic ________ _____________, that is compensated by increased renal excretion of bicarb

A

Respiratory alkalosis (hyperventilate , blow off CO2)

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25
Q

Besides Histamine, what is another marker of anaphylaxis, that is released from mast cells?

A

TRYPTASE

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26
Q

-a pt with a chronic disease, has hypoxia and hypercapnia, blood flow to the brain will be incrs or decrs??

A

Increased

  • hypercapnia causes cerebral vasodilation
  • this is common in people with COPD (be careful starting them on Oxygen b/c hypoxia drives their respiratory function– so taking away their hypoxia state could decrease their respiratory drive)**
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27
Q

epithelium type of the TRUE VOCAL CORDS

A

Stratified Squamous Epithelium

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28
Q

the equilibrium of O2 in a normal person at rest is ________ limited

A

Perfusion limited

  • the air is in the alveoli, exchange depends on the amount of perfusion to the lungs
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29
Q

Mucociliary clearance is so effective that only particles ______ mm or smaller actually reach the alveoli and must be cleared by phagocytes

A

2 mm

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30
Q

Main effect of vagus nerve on lungs

A

bronchial smooth muscle constriction & incrs mucous secretion

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31
Q

prolonged untreated sleep apnea can have what effect on the heart and lungs?

A
  • each nocturnal episode of decrs ventiliation leads to transient hypercapnea and hypoxemia
  • causes systemic and pulmonary vasoconstriction and sympathetic cardiac stimulation
  • can lead to pulmonary HTN and Right Heart Failure!
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32
Q
  • inflammation of the nasal mucosa
  • mostly caused by Adenovirus
  • sneezing, cough, runny nose
A

**Rhinitis (common cold) **

-etiology can be viral (Adenovirus) or Allergic Rhitnitis

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33
Q

Young child with nasal polyps should be evaluated for _____________

A

Cystic Fibrosis

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34
Q

benign nasal mucosa tumor in young males, with profuse epistaxis

A

Angiofibroma

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35
Q

Malignant tumor of epithelium in the nasopharynx, African children or Asian adults, keratin + biopsy, assoc with a virus

A

Nasopharyngeal Carcinoma

  • assoc with EBV
  • cervical lymphadenopathy 1st sign
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36
Q

child w/ high fever, sore throat, drooling, dysphagia, stridor

A

Epiglottitis

  • caused by H. flu
  • med emergency **
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37
Q

inflammation of the upper airway caused by parainfluenza virus

A

Laryngotracheobronchitis (Croup)

  • hoarse, ‘barking’ cough & stridor
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38
Q

benign papillary tumor on the true vocal cords, due to HPV 6 or 11

A

Laryngeal Papilloma (warts)

  • single in adults
  • multiple in babies
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39
Q

Clnical picture of fever, chills, productive cough w/ yellow/green or bloody sputum, tachypnea, pleuritic chest pain, decreased breath sounds, dullness to percussion, elevated WBC count

A

Pneumonia

  • infection of the lung parenchyma
  • can be bacterial, viral
  • 3 patterns —> Lobar, bronchopneumonia or interstitial
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40
Q

Most common cause of community acquired lobar pneumonia

A

Strep pneumoniae (95%)

41
Q

pneumonia w/ ‘currant jelly’ sputum

A

Klebsiella pneumoniae

  • thick sputum b/c the bacteria has a thick, mucoid capsule
42
Q

Type of pneumocyte that can regenerate both type 1 & 2 pneumocytes

A

Type 2

43
Q

type of pneumonia w/ scattered patchy consolidations, centered around the bronchioles

A

Bronchopneumonia

  • bacterial cause
44
Q

pneumonia w/ mild symptoms, minimal sputum, low fever, associated more w/ virual causes

A

Interstitial (atypica) pneumonia

  • # 1 bac cause –> Mycoplasma pneumonia
  • Viral causes –> CMV, RSV, Influenza
45
Q

2 main causes of lobar pneumonia

A

1- Strep. pneumo –> normal community acquired

2- Klebsiella –> malnourished, elderly, nursing homes, alcoholics, pts at aspiration risk

46
Q

cause of secondary bacterial lung infection on top of a viral illness

A

Staph aureus

47
Q

cause of bronchopneumonia in patients with Cystic Fibrosis

A

Pseudomonas aeruginosa

48
Q

community acquired pneumonia, transmitted from water source

A

Legionella pneumophilia

49
Q

cause of atypical pneumonia in the elderly, immunocompromised, and those with preexisting lung dz

A

Influenza virus

50
Q

atypical pneumonia w/ high fever (“Q fever”) in farmers/ veterinarians, transmitted by ticks on cattle

A

Coxiella burnetii

51
Q

First exposure to TB causes:

A
  • focal, caseating necrosis that undergoes fibrosis –> **GHON COMPLEX **
  • asymptomatic but + PPD test
52
Q

Secondary TB arises with the reactivation of the bacteria (commonly due to AIDS) and symptoms include:

A
  • fever, night sweats, chills, cough, hemoptysis, weight loss
  • can spread all over body (lumbar vertabrae is caleled “Pott’s dz”)
53
Q

Lung dz with decreased FVC, FEV1 and decreased FEV1/ FVC ratio

A

Obstructive lung diseases

  • TLC is increased due to air trapping
54
Q

cough lasting at least 3 months over a minimum of 2 years , assoc with smoking

A

Chronic Bronchitis

  • hypertrophy of mucous glands
  • incresaed thickness of mucous glands compared to overall bronchial wall (“REID INDEX > 50% )
55
Q

smoking causes _______ emphysema

and A1-antitrypsin deficiency causes __________ emphysema

A
  • centriacinar
  • panacinar
56
Q

PiZZ allele associated w/ __________

A

panacinar emphysema & cirrhosis

57
Q

cell mediators in asthma

A

Th2 cells – secrete IL-4, IL-5 & IL-10

58
Q

diseases associated with _Bronchiectasis _

A

1- Cystic Fibrosis

2- Kartageners

3- Tumor or foreign body

4- Necrotizing infection

5- Allergic bronchopulmonary aspergillosis

59
Q

decreased TLC, FVC, and FEV1….. but *FEV1/FVC ratio is increased *

A

Restrictive lung diseases

60
Q

end stage is “honey comb” lung appearance

A

Idiopathic Pulmonary Fibrosis

  • TGF-beta from the injured cells causes the fibrosis
  • tx = lung transplant
61
Q

Interstital lung fibrosis due to occupational exposures to small particles..

A

Pneumoconioses :

  • Coal Worker’s (black lung)
  • Silicosis
  • Berylliosis (NASA workers/ aerospace work)
  • Asbestosis
62
Q

NON-caseating granulomas

A
  • Sarcoidosis (assoc w/ AA women)
  • Berylliosis (assoc with aerospace workers)
63
Q

young adult female w/ **inactivating mutation of BMPR2 **

A

Primary Pulmonary HTN

  • can lead to cor pulmonale
64
Q

formation of hyaline membranes thickens the air exchange barrier, “white out” on CXR

A

Acute Resp Distress Syndrome (ARDS)

  • free radical damage of both type 1 & 2 pneumocytes
  • hundreds of causes
65
Q

solitary ‘coin lesion’ on CXR

A
  • Lung Cancer
  • benign granuloma
  • bronchial hamartoma
66
Q

type of lung cancer NOT amendable to surgery, assoc with male smokers, central location , has many paraneoplastic syndromes

A

Small cell carcinoma

67
Q

most common lung tumor in male smokers, central location , may produce PTHrP (& cause hypercalcemia)

A

Squamous Cell Carcinoma

68
Q

Most common lung tumor in non-smokers and female smokers

A

Adenocarcinoma

  • glands / mucin
  • peripheral location
69
Q

Lung cancer with columnar cells growing along bronchioles and alveoli, arise from CLARA CELLS, not related to smoking, peripheral, GREAT PROGNOSIS

A

Bronchoalveolar Carcinoma

70
Q

Most common overall lung cancer

A

METASTASIS form other cancers

71
Q

rupture of an emphysematous bleb in young adults

A

Spontaneous Pneumothorax

  • trachea deviates TOWARD collapsed lung
72
Q

penetrating chest wall injury, air enters with each breath but can’t escape, trachea deviates away from collapsed lung

A

Tension Pneumothorax

73
Q

definition of a Ghon complex

A

-a lower lobe fibrotic lung lesion w/ an ipsilateral calcified lymph node — sign of primary exposure to TB

74
Q

bronchiolitis obliterans is assoc w/ _______ lung transplant rejection

A

CHRONIC rejection

75
Q

a cavitary lesion on CXR with an air-fluid level

A

**Lung abscess **

  • ususally a result of aspiration
  • fever, weight loss, cough, foul smelling sputum
76
Q

FNA of a lung lesion in your patient shows Fusobacterium, Peptostreptococcus, or Bacteroides –> what do you think caused it?

A

ASPIRATION of oropharyngeal contents

  • these are anaerobic bacteria
  • assoc w/ alcoholism, seizure disorders, dementia, CVA
77
Q

a worker exposed to Asbestos is at greatest risk for developing ______________

A

1- Bronchogenic carcinoma

2- Mesothelioma (less common than cancer)

3- Asbestosis

78
Q

a pt with acute pancreatitis is at risk for what serious lung complication?

A

ARDS

  • hyaline membranes in alveoli
79
Q

N-acetylcysteine works as a mucolytic by:

A

cleaving disulfide bonds within mucous –> loosening thick sputum

-used in CF and in Tylenol overdose …

80
Q

administering ________________ to at risk HIV + patients (CD4+ count < 50) weekly can decrease their chance of Mycobacterium Avium-Intracellulare infections

A

Azithromycin

81
Q

a patient is put on inhaled corticosteroids for asthma not well controlled with Albuterol alone… what should you instruct them to do after each puff?

A

Rinse their mouth out

  • these pts are at risk for oral candidiasis
82
Q

What are the 4 phases of Lobar pneumonia?

A

1- Congestion (first 24 hours) - lobe is red, heavy, boggy

2- Red Hepatization (2-3 days) - red, firm lobe

3- Gray Hepatization (4-6 days) - gray / pale firm lobe

4- Resolution - enzymatic digestion of the exudate

83
Q

high circulating levels of _________ increase the ESR (a non specific marker for inflammation)

A

fibrinogen ( an acute phase protein)

  • brought on by IL-6, IL-1 and TNF-alpha
84
Q

use of oxygen therapy in premature neonates can cause _________

A

retinopathy

  • oxygenation induces VEGF in the retina after return to normal room air
  • can lead to blindness
85
Q

Leukotriene C4, D4 & E4 receptor blockers are useful treatments for ___________

A

Atopic / allergic asthma

86
Q

Children who develop asthma have an imbalance of Th1 to Th2 lymphocytes….which one do they have more of?

A

Th2

87
Q

antifungals that inhibit the synthesis of the fungal CELL WALL

A

Caspofungin & Micafungin

88
Q

Which TB medication requires an acidic environment to kill the bacteria and therfore is most useful against the INTRACELLULAR organisms??

A

**Pyrazinamide **

  • works best in acidic places
  • kills TB within the macrophage phagolysosomes
89
Q

mycobacterium treated with drug X lose their “acid fastness” and stop proliferating, which TB drug is being used?

A

ISONIAZID

  • inhibits the synthesis of mycolic acids (cell wall)
90
Q

Pneumoconiosis that produces calcified hilar lymph nodes and birefringent particles surrounded by dense collagen fibers

A

**Silicosis **

  • densities form in upper lobes
  • increases your risk for TB
91
Q

drug that blocks endothelin receptors , is used to treat Primary Pulmonary HTN (by decreasing pulmonary arterial pressure and lessening the progression of RVH)

A

BOSENTAN

92
Q

most notable side effect of the TB drug, Ethambutol ….

A

OPTIC NEURITIS

  • presents as decrs visual acutiy, scotomas, color blindness
93
Q

localized pleural thickening with calcification –> pt probably exposed to :

A

Asbestos

94
Q

best imaging test for a suspected PE

A

Helical CT

95
Q

Why do babies born to mothers with diabetes have decreased surfactant ?

A

b/c Insulin decreases surfactant production

((the babies have been exposed to high glucose and therfore have been secreting a lot of Insulin))

96
Q

non-specific Beta-agonist , used in Asthma to relax bronchial smooth muscle , but also has side effect of tachycardia

A

Isoproterenol

97
Q

Beta-2 agonists for Asthma treatment

A
  • Albuterol –for acute attacks
  • Salmeterol –long acting, for prevention of attacks
98
Q

Asthma drug that prevents mast cell degranulation, onlt used for prevention, not for acute asthma attacks

A

Cromolyn sodium

99
Q
A

STEP 1 RECALL (12 decks)

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