Respiratory1 Flashcards
Which cells secrete surfactant? What is the most important lecithin in surfactant?
Type II cells.
Diplamitoylphosphatidylcholine is the most important lecithin.
What are the vertebral levels of the IVC, esophagus and aorta?
IVC: T8
Esophagus: T10
Aorta: T 12
“I ate 10 eggs at twelve.”
What is the inspiratory reserve volume?
Air that can still be inspired after normal inhalation.
What is tidal volume?
Quiet/normal inspiration (~500mL).
What is expiratory reserve volume?
Air that can still be expired after normal expiration.
What is the residual volume?
The air that you can’t get rid of.
What is vital capacity?
IRV + TV + ERV
What is total lung capacity?
The sum of all the parts, ~6L
What is Hg made up of?
4 parts: alpha 1/2, beta 1/2
There is a fetal Hg, too, which has a greater affinity for O2 than adult Hg.
What is methemoglobin?
Hg with oxidized Fe3+ instead of the normal Fe2+. It does not bind to O2 as well. “Chocolate brown blood.”
What does “ACE BATs Right” stand for?
Things that RIGHT shift the dissociation curve.
Altitude CO2 Exercise BPG (2,3-BPG) Acid (low pH) Temperature
What is the most important aspect regarding pulmonary resistance?
Radius.
Resistance = 8nl/(pi x r^4)
What are the two types of hypoxemia?
Normal A-a gradient: high altitude, hypoventilation
Increased A-a gradient: V/Q mismatch, diffusion limitation, R to L shunt.
What are four causes of hypoxia?
Decreased cardiac output
Hypoxemia
Anemia
CO poisoning
What’s the difference in FEV1/FVC in obstructive vs. restrictive lung disease?
Restrictive: FEV1/FVC >= 80%
Obstructive: FEV1/FVC
What are some causes of pulmonary HTN?
Primary: inactivation mutation of BMPR2, leads to proliferation of smooth muscles, poor prognosis.
Secondary: COPD, mitral stenosis, recurrent thromboemboli, autoimmune (SLE), sleep apnea, high altitude
What is a hallmark of Obesity Hypoventilation Syndrome?
The pt gets used to being hypoxic, the thermostat gets reset.
decreased PaO2 and increased PaCO2 during waking hours.
What are common complications to lung cancer?
SPHERE
Superior vena cava syndrome Pancoast tumor Horner syndrome Endocrine (paraneoplastic) Recurrent laryngeal Effusions (pleural and pericardial)
Tell me some stuff about adenocarcinoma.
Most common primary lung cancer in non-smokers.
Mutations: k-RAS, EGFR and ALK
Tell me some stuff about squamous cell carcinoma.
Cavitation
Cigarettes
Calcium (produces PTHrP)
Histology: keratin pearls and intercellular bridges (looks like tram tracks)
Tell me some stuff about small cell carcinoma.
Very aggressive, undifferentiating, inoperable
ACTH production (Cushing’s symptoms)
ADH production
Amplification of myc oncogenes
Abs against presynaptic Ca++ channels (Lambert-Eaton syndrome with proximal muscle weakness)
Tell me some stuff about large cell carcinoma.
Highly anaplastic tumor, poor prognosis, surgery works about 50% of time.
Tell me some stuff about bronchial carcinoid tumor.
Histology: rosette pattern
Best prognosis
Symptoms due to mass effect, occasionally carcinoid syndrome (5-HT like syndrome)
What is a pancoast tumor?
Carcinoma in apex of lung. Can cause Horner syndrome (ptosis, miosis, anhydrosis).
