Shit -Respiratory Flashcards
club cell functions
- Secrete component of surfactant
- degrade toxins
- Reserve cells
VIP surfactant lecithin
dipalmitoylphosphatidylcholine
Lecithin:sphingomyelin ratio
>2 in amniotic fluid = mature lungs
Aspiration: upright vs supine
upright = inferior of R. inf. lobe
supine = superior of R. inf. lobe
Collapsing pressure on alveoli equation
Pc = 2 (ST) / r
Physiological deadspace calculation
phys deadspace = anatomical + alveolar
VD = VT + VA
P1V1 = P2V2
VA*PA = VT*PT
(VT-VD)*PaCO2 = PECO2*VT
Lung area providing most of alveolr dead space
Apex
(because decreased BF)
Minute ventilation
=VT*RR
Alveolar ventilation
= VA*RR
= (VT - VD)*RR
Taut vs Relaxed Hb
Taut = tissues = low affinity for oxygen
Relaxed = respiratory = high affinity
Hb exhibits:
positive cooperativity and negative allosterity (23DPG decreases affinity)
Cheynne stokes breathing:
delayed response but high sensitivity to PCO2
MetHb: what, how, s/s, rx, use
Hb 3+
Nitrites, benzocaine, dapsone
s/s = cyanosis/dusky skin (baby with sulfa drug)
Rx = Vitamin C + methylene blue
Use: rx for cyanode poisoning (Hb3+ has increased affinity for cyanide)
cyanide poisoning s/s
rapidly developing tachypnea, tachycardia, flushing, HA, NV, confusion, weakness
Severe lactic acidosis with low A-V gradient
Burnt almond smell
Left shift seen with:
CO
Fetal Hb (dereased 23DPG binding)
Myoglobin (no + cooperativity)
Perfusoin vs. diffusion limited
Perfusion = normal
Diffusion = emphysema or fibrosis
During exercise still perfusion, but close
PVR equation
PVR = (Ppulm a. - Pwedge (LA) )/CO
Alveolar gas equation
PAO2 = PIO2 - (PaCO2/R)
HYpoxemia (low PaO2) via:
High altitude
Hypoventilation
V/Q mismatch
Diffusion-limited
right-to-left shunt
where in lung are ventilation and perfusion greatest?
base
shunt vs dead space
shunt = V/Q = 0
(no ventilation; blood shunted away)
deadspace = V/Q = œ
(no blodo flow, so like a dead space)
Exercise and VQ
increases Q at apex via vasodilation; lung zones more uniform
Haldane vs Bohr
Haldane = lung
Bohn = peripher
Bacterial superimposed infections on rhinosinutisis
s. pneumoniae
h. flu
m. catarrhalis
Samter’s triad
ASA-intolerance:
- asthma
- nasal polyps
- bronchospasms
Epistaxis locations
MC = ant = Kisselback plexus
Most severe = post = sphenopalatine artery
pleuritic chest pain with tachycardia and tachypnea
PE
Fat embolism triad
- Hypoxemia
- Neurological
- Petechial rash
PE test
CT angiography
Reid index
Chronic bronchitis
>50% from LP to MP is glands
Curshman spirals vs. Charcot-leyden crystals
Curshman spirals = shed epithileum
Charcot = eosinophil breakdown releases MBP; hexagonal double-needle crystals
pulsus paradoxus seen in:
cardiac tamponade, pericarditis, croup, asthma, OSA
Chronic necrotizing infection of bronchi: disease, causes
Bronchiectasis
Poor ciliary motility (CF, Kartageners, smoking), bronchial obstructions (tumour, foreign body), allergic bronchopulmonary asthma
Elastase: from where, what breaks it down?
PMN; A1-AT
Macrophages; TIMPS
sarcoidosis causes increased:
Ca and ACE
Restrictive disease with eosinophilic granulomas
langerhans cell histiocytosis or hypersensitivity pneumonitis
drugs causing restrictive lung disease
Bleomycin, busulfan, MTX, amiodarone
Decreased FVC and FEV1 seen in:
BOTH obstructive and restrictive
obstructive has much lower FEV1
Hypersensitiyivty pneumonitis: who, s/s, histo
farmer/bird people
s/s = dyspnea, cough, tight chest, headache
histo = type III and IV (non-caseating granulomas in alveoli)
pneumoconiosis complications
cor pulmonale
Caplan syndrome: RA + intrapulmonary nodules
lobe and pneumoconiosis
Lower = asbestos
Uppers = beryliosis, coal workers, silliosis
pneumoconiosis with pleural and superdiaphragmatic nodules
Asbestosis
ferruginous bodies
asbestosis; golden-brown dumbbells in alveolar septae
Job and pneumoconiosis:
- roofer, plummer, shipbuilder
- aerospace + manufacturing
- coal
- foundries, sandblasting, mines
- roofer, plummer, shipbuilder: asbestosis
- aerospace + manufacturing: berylliosis
- coal: CWP
- foundries, sandblasting, mines: sillicosis
lecithin:spingomyelin
NRDS
complications of NRDS:
metabolic acidosis
PDA
necrotizing enterocolitis
complications of NRDS Rx (supplemental O2)
Retinopathy of prematurity
Intraventricular hemorhage
Bronchopulmonary dysplasia
Causes of ARDS
trauma, sepsis, shock, gastric aspiration, uremia, backterial pneumonia, acute pancreatitis, amniotic fluid embolism
complications of nocturnal hypoxia in sleep apnea
systemic/pulmonary HTN
arrythmyas (a fib//flutter)
sudden death
plexiform lesions
tufts of capillaries after long term PulmHTN
Pulmonary arterial hypertension (PAH)
1’ = BMPR2 activating mutation (2 hits), AD, variable penetrance, no prevention of sm proliferation
2’ = long-term cocaine/amphetamines (appetitie suppressants), CT disease, HIV, portal HTN, congenital heart disease, schistosomiasis.
Pther 2’ PHTN: hypoxic VC, lung destructoin, recurrent microthrombi
Trachea movements and lung lesiosn
AWAY = large pleural effusion or tension pneumothorax
TOWARDS = atelectasis or simple pneumothorax
increased fremitus
consolidation ONLY i.e. lobar pneumonia, pulmonary edema
signs of consolidation (lobar pneumonia, pulmonary edema)
- tactile fremitus
- dull resonance
- bronchial breath sounds
- late inspiratory crackles
chylothorax via:
Thoracic duct injury (left) from trauma or malignancy
Lung abscess: via disease + bugs; classic sign, Rx
Disease = aspiratoin of OROPHARYNGEAL contents or bronochial obstruction
Bugs = fusobacterium, peptostreptococcus, bacteroides, s. aureus
Classic sign = air-fluid level
Rx = clindamycin (anaerobes above diaphragm)
Mesothelioma can cause:
hemorrhagic pleural effusion (exudate), pleural thickening, psammomma bodies
mesothelioma RFs
asbestos (MC cause lung cancer)
NOT smoking
Pancoast tumour can casue: (4)
SVC syndrome [also via catheter thrombosis]
Horners
hoarseness
sensorimotor deficits
lung cancers mets to:
lung cancer mets from:
TO: adrenals, brain, bone, liver
FROM: breast, colon, brostate, bladder
Paraneoplastics in lung cancer:
small cell = ACTH, SIADH, Lamber-Eaton
Squamous cell = PTHrp
Gene mutatoins in lung cancers:
small cell = amplification of L-myc
adenoCA = activating mutations in KRAS, EGFR, ALK
Squamous cell = erb-B1
Markers in lung cancer
small = neuroendocrine (chromogrannin A, synaptophysin, enolase, neurophysin); kulchinsky cells
Adeno = mucin
Squamous = keratin and intercellular bridges
large = b-HCG
brochial carcinoid = neuroendocrine
chemo vs surgery for lung cancer:
small cell = chemo
large cell = surgery