Respiratory System Flashcards
What disease has these symptoms - progressive dyspnea + fine crackles + clubbing + diffuse reticular opacities?
Interstitial lung disease (Restrictive)
What disease has these spirometry findings
- very decreased FVC
- decreased FEV1
- decreased TLC
- decreased RV
- increased FEV1/FVC ratio
Interstitial lung disease (Restrictive)
Where is RNA Polymerase I functional? and what does it do?
RNA Polymerase I is functional in the nucleolus.
It produces rRNA and promotes ribosomal maturation and assembly.
What is the main stimulator of respiratory rate in healthy individuals? And which chemoreceptors are stimulated?
increase in PaCO2 -> decrease in pH (increase in H+ ions) -> (+) central chemoreceptors
What is the main stimulator of respiratory rate in patients with COPD? And which chemoreceptors are stimulated?
What happens if you give these patients 100% Oxygen?
decrease in PaO2 -> (+) peripheral chemoreceptors
if you give these patients 100% oxygen therapy -> their PaO2 rises -> stops stimulating peripheral chemoreceptors -> drive to breathe stops
What disease has the following symptoms - daytime somnolence + non-restorative sleep + morning headaches + affective/cognitive symptoms (ex: depression)?
Obstructive Sleep Apnea
What proteins do eosinophils release? What are its two functions/consequences?
Eosinophils release major basic protein.
Functions/Consequences =
-kills helminths
-damages bronchial epithelium
What is the CFTR Cl channels’ function in normal respiratory mucosa?
- Increases efflux of Cl into the lumen
- Inhibits ENaC function to decrease Na (and H2O) reabsorption from the lumen
- Overall, puts/keeps Cl, Na, H2O in the lumen
What is the CFTR Cl channels’ function in normal sweat glands?
- Increases Cl absorption from the lumen
- Stimulate ENaC function to increase Na (and H2O) absorption from the lumen
- Overall, brings Cl, Na, H2O out of lumen (keeps them out of sweat)
Sharp localized severe pain exacerbated by breathing, coughing, or changing positions =
Pleuritic chest pain
Nerves involved in pleuritic chest pain and the parts of the pleura they innervate (2)
- Phrenic nerve - diaphragmatic and mediastinal pleura
- Intercostal nerve - all other parts of the pleura
Definition of polycythemia/erythrocytosis
Definition = increased amount of hematocrit
How to diagnose Legionella?
Urine antigen test
Which bug - high fever + cough + confusion + diarrhea + on a cruise/immunocompromised + hyponatremia + patchy infiltrates in lung + sputum shows neutrophilia but no bacteria?
Legionella pneumophilia
What is the piriform recess?
Which nerve runs through it?
What reflex is impaired if that nerve is severed?
Piriform recess = fossas on either side of the larynx that are bounded medially by the aryepiglottic folds
Superior laryngeal nerve runs through it (branch of CN X)
Often, a fish/chicken bone (small) gets stuck here and the nerve can be severed. This results in a loss of the afferent limb of the cough reflex.
Cheyne-Stokes Breathing is seen in what disease?
Advanced congestive heart failure
Kussmaul breathing is seen in what condition?
Metabolic acidosis
What are all the causes of Kussmaul breathing?
mnemonic
K = diabetic ketoacidosis U = uremia S = sepsis S = salicylates M = methanol A = aldehydes U L = lactic acidosis
Dyspnea + Bibasilar crackles + S3 + recent MI =
Left heart failure
What is the pathogenesis of dyspnea in left heart failure?
LHF -> increased EDP -> decreased VR from pulmonary circulation -> increased hydrostatic pressure in the pulmonary circulation -> fluid moves compartments into the pulmonary interstitum -> decreased compliance of lungs -> dyspnea
Which bacteria is associated with “currant jelly sputum”?
Klebsiella
Klebsiella preferentially attacks which populations? (3)
- Alcoholics
- Hospitalized patients
- Diabetics
What effect does ether have on enveloped vs non-enveloped viruses?
Ether disrupts the viral envelope therefore inactivating enveloped viruses.
Non-enveloped viruses are resistant to ether.
Which leukotrienes play a role in asthma? (3)
LTC4
LTD4
LTE4
Which cells have secretory activity in the terminal bronchioles?
Clara/Club cells - secrete a surfactanty-mucusy substance
No mucous cells here
Peptrostreptococcus, Fusobacterium, Bacterioides are _ bacteria that are normally found _ but are also found in what lung lesion?
- Anaerobic bateria
- Normally found in the oropharynx
- Can also be found in lung abscesses
Oral thrush + Interstitial pneumonia + Lymphopenia + Within the first year of life =
Vertical transmission of HIV-1
Anti-retroviral therapy (ART) recommended for pregnant females infected with HIV?
2 nucleoside/nucleotide reverse transcriptase inhibitors + 1 (protease inhibitor OR non-nucleoside reverse transcriptase inhibitor OR integrase inhibitor)
Same ART as is for all HIV-infected adults. It is just very important for pregnancy because it drastically lowers the rate of vertical transmission.
Panic attacks cause what changes in PaCO2, pH and cerebral blood flow?
- decreased PaCO2
- decreased cerebral blood flow caused by vasoconstriction
- increased pH
respiratory alkalosis
First line therapy for chronic asthma?
Glucocorticoids
Asbestos is from the a but it affects the b of the lungs.
Silicone and Coal are from the c but they affect the d of the lungs.
a = roof b = base
c = ground d = top
PRP (polyribosyl-ribitol-phosphate) antibody is effective against what bacteria?
Haemophilus influenzae type B
Capsule of Type B is made of a polymer consisting of ribose + ribitol + phosphate = PRP
Mycoplasma pneumoniae infection produces antibodies that are cold/warm agglutinins?
cold agglutinins
Two infections that form cold agglutinins?
- Epstein-Barr virus
- Mycoplasma pneumoniae
Treatment of oral candidiasis?
Nystatin = binds ergosterol in fungal cell membranes forming pores -> cell lysis
Which drug is used for an alcoholic with a lung abscess + productive cough with foul smelling sputum?
Clindamycin = binds to bacterial 50S ribosomal subunit to inhibit protein synthesis
The lung abscess is probably caused by anaerobic oropharyngeal bacteria that have been aspirated. It is also important to cover the most common cause of community acquired pneumonia (Strep pneumo - aerobic gram positive bacteria)
Acid Fast Stain - what color do mycobacteria stain and what color do non-mycobacteria stain?
Mycobacteria = red - initial carbolcushsin stain sticks to the mycolic acids in the cell wall
Non-mycobacteria = blue - initial stain washes off and the counterstain sticks to the bug
Most common cause of community acquired pneumonia?
What are its virulence factors?
Streptococcus pneumoniae
Virulence factors:
- polysaccharide capsule
- IgA protease
- adhesins
- pneumolysin
Minute ventilation vs Alveolar ventilation
Minute Ventilation = amount of air entering the respiratory tract = VT x RR
Alveolar Ventilation = amount of air entering the alveoli = (VT-DS) x RR
The difference between the two is the inclusion of dead space in the minute ventilation
Mucicarmine staining is used to identify =
Cryptococcus neoformans - stains the polysaccharide capsule red (this is the only fungi with this kind of capsule)
Tracheal deviation towards the problem side is caused by (2)
Tracheal deviation away from the problem side is caused by (1)
Towards:
-Rupture of an emphysematous bleb -> spontaneous pneumothorax = increased lucency on the affected side
-Obstruction of a mainstem bronchus -> air that is trapped in the lungs is absorbed into the blood -> alveolar collapse = complete opacification on the affected side
Away:
-Tension pneumothorax caused by air entering the pleural space but not being able to escape
Transudate vs Exudate
Transudate = ultrafiltration of plasma caused by hemodynamic changes
Exudate = extravasation of plasma water + small ions + plasma proteins + leukocytes - seen in inflammatory states
What is “lead time bias” and when should it be considered?
Lead Time Bias = Artificial increase in survival time among tested patients who actually have unchanged prognosis. Occurs due to the fact that the disease was detected earlier than it would have been otherwise. Makes it look like the patient lives longer.
-Should be considered when evaluating any screening test for a disease with a poor prognosis.
Alveolar gas equation is used to calculate what?
PAO2 = [FiO2 x (PB - PH2O)] - (PaCO2/R)
if using sea level values:
PAO2 = 150 - (PaCO2/0.8)
What is responsible for the green color in pus/sputum from a bacterial infection?
Neutrophil myeloperoxidase - blue green heme based pigment contained in azurophilic granules
Secondary bacterial pneumonia post-influenza infection occurs via which bugs? (3)
- Streptococcus pneumoniae
- Stapholococcus aureus
- Hemophillus influenzae
Which fungus can live intracellularly? And in which cell is it found?
Histoplasma capsulatum.
Can be found in macrophages.
Hyperventilation does what to PaCO2?
lowers PaCo2 -> respiratory alkalosis
Mutation in BMPR2
Hereditary Pulmonary Arterial Hypertension
Results in the proliferation of endothelial and smooth muscle cells -> increased endothelin, decreased NO, decreased prostacyclin
Increases or Decreases P50?
increased H+ (acidic) increased CO2 increased exercise increased 2,3-DPG increased altitude increased temp
Increased P50 -> decreases Hb affinity for O2
Right shift
All of those situations require more oxygen to be dropped off at the tissues
Patient who has recurrent sinusitis + hematuria + hemoptysis. Lung biopsy shows large serpiginous necrosis with peripheral palisading macrophages.
Granulomatosis with polyangiitis
Asthma: Increased or Decreased DLCO?
Increased diffusing capacity for CO due to the increase in capillary blood vessels
Emphysema: Increased or Decreased DLCO?
Decreased diffusing capacity for CO due to the alveolar and capillary destruction
Tumor cells with numerous long, slender microvilli + abundant tonofilaments
Mesothelioma
Chronic lung transplant vs Chronic kidney transplant
Lung: inflammation (lymphocytes) of small airways/bronchioles (“bronchiolitis obliterans”)
-Inflammation -> fibrosis -> narrowing
Kidney: vascular obliteration
What cell predominates in the BAL of a sarcoidosis patient?
CD4+ T cells
Treatment to prevent neonatal GBS?
- Intrapartum penicillin
- Intrapartum ampicillin
Main variable that is decreased in obesity-related restrictive lung disease?
Decreased ERV
Therefore FRC is also decreased (ERV + RV)
What is the superior sulcus?
Groove formed by the subclavian vessels at the lung apex
Location of a pancoast tumor
On LM of the lungs: Patchy involvement with dense fibrosis + Cystic spaces + more prominent in the subpleural and paraseptal spaces
Idiopathic pulmonary fibrosis
Lung tumor - activating mutation of KRAS, EGFR, ALK oncogenes =
Adenocarcinoma
Lung tumor - amplification of myc oncogene =
Small cell carcinoma
Lines of Zahn indicate
Clots formed before death - alternating lines of RBCs and fibrin
Life threatening epistaxis in the posterior segment of the nasopharynx involves what artery?
Sphenopalatine artery (branch of the maxillary artery)
Intrapulmonary shunt - what is happening to ventilation and perfusion?
Perfused but not ventilated
Opposite of “Dead space” - ventilated but not perfused
First step in a mycobacterial infection?
Mycobacteria are phagocytosed in macrophages and those macrophages become inactivated by sulfatide so that they mycobacterium can proliferate
19 yo + celiac disease + recurrent pneumonia infections + anaphylaxis when given a O- blood transfusion =
IgA deficiency
Asymptomatic, Airway/GI infections, Autoimmune diseases (Celiac), Atopy/Anaphylaxis when given IgA products (transfusions contain small amounts of IgA)
Meconium ileus found in a newborn indicates that infant will be dx with what disease later in life:
Cystic fibrosis
Central U.S. patient + pulmonary symptoms + calcified masses seen in lungs + HIV positive =
Histoplasma capsulatum
Blastomycosis can also present with calcified masses but the location of the patient (Eastern U.S.) and the histological appearance of the fungus will be different
Post-viral pneumonia + abscess formation in the lungs + salmon colored sputum =
Staph aureus
MVA + acute onset hypoxemia + bilateral pulmonary infiltrates + hypotension =
Acute Respiratory Distress Syndrome
Inciting factor = endothelial damage or pneumocyte damage
25 year old woman came to the ED with trouble breathing, prolonged expirations and expiratory wheezes. Treatment with a nebulizer and she began to breathe easier in 20 minutes. What did they give her?
Beta-2 agonist ->(+)Gs -> increases cAMP
decrease in PAO2 does what to pulmonary vasculature
hypoxic vasoconstriction - shifts blood away from poorly ventilated areas
Hypoxemia (low PaO2) with a normal A-a gradient (2)
- high altitude
- hypoventilation
Hypoxemia (low PaO2) with an elevated A-a gradient (3)
- V/Q mismatch
- diffusion limitation
- R->L shunt
Hypoxemia =
low PaO2
Hypoxia =
4 causes
low O2 delivery to tissues
causes:
- decreased CO
- hypoxemia
- anemia (decreased Hb)
- CO poisoning
3 consequences of untreated, chronic OSA
- systemic hypertension
- pulmonary hypertension
- right heart failure
how to distinguish from relative erythrocytosis and absolute erythrocytosis
RBC mass
- normal RBC mass indicates relative (decreased volume via diuresis or dehydration)
- elevated RBC mass indicates absolute (increased Epo)
