Term
| Where does the respiratory zone start? Where is cartilage present in the resp tree? |
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Definition
Resp zone starts at resp bronchioles
Cartilage in trachea and bronchi |
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Term
| Where are goblet cells in the lung? |
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Definition
Only down to the bronchi
pseudostrat ciliated columnar cells go down to the resp bronchioles |
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Term
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Definition
| nonciliated, columnar w/ secretory granules. Secrete component of surfactant, degrade toxins and act as reserve cells |
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Term
| What does a bronchopulmonary segment consist of? |
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Definition
| tertiary bronchus and 2 arteries (bronchial and pulmonary) in center, veins and lymphatics along borders |
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Term
| Where do aspirated particles go while upright or supine? |
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Definition
Upright = lower portion of RIGHT inferior lobe
Supine = superior portion of RIGHT inferior lobe |
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Term
| What is the relationship of the pulmonary artery to the bronchus at the lung hilus? |
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Definition
RALS
Right Anterior, Left Superior |
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Term
| Where do the IVC, esophagus and aorta penetrate the diaphragm? |
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Definition
T8 = vena cava
T10 = esophagus
T12 = aorta |
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Term
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Definition
ACtivates the kinin cascade (increased vasodilation, increased permeability, increased pain)
Inactivated by ACE, so ACEi's cause increased in bradykinin --> cough |
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Term
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Definition
activates bradykinin
produced in the lung |
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Term
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Definition
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Term
| What are the 2 forms of hemoglobin? Which has a higher affinity for O2? |
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Definition
T and R
R has a higher O2 affinity
When you're Relaxed, you do your job better (carry O2) |
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Term
| What things favor the T form of Hb (lower O2 affinity so unloading of O2)? |
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Definition
| Right shift = CADET face RIGHT (CO2, Cl, Acid/altitude, DPG, Exercise, Temp) --> All INCREASED |
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Term
|
Definition
Oxidized Hb, has a higher affinity for CN-
Tx w/ Methylene blue |
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Term
| What is cyanide poisoning treated with? |
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Definition
| Nitrites to oxidize Hb to methemoglobin (to bind cyanide) then thiosulfate to bind cyanide, forming thiocyanate which is renally excreted |
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Term
| What changes occur to Hb in carboxyhemoglobin? |
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Definition
CO bound in place of O2.
Causes decreased O2 binding capacity w/ a L shift --> decreased O2 unloading in tissues
CO has a 200x greater affinity for Hb than O2 |
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Term
| What things are perfusion limited? Diffusion limited? |
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Definition
Perfusion-limited = O2, CO2 and N2O --> equilibrates quickly
Diffusion-limited = O2 (emphysema, fibrosis), CO --> doesn't equilibrate fast enough |
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Term
| What defines pulmonary hypertension? |
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Definition
pulm a pressure >25 mmHg of >35mmHg during exercise
Results in atherosclerosis, medial hypertrophy and intimal fibrosis of pulm arteries |
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Term
| What is the cause of primary pulmonary hypertension? |
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Definition
inactivating mutation in BMPR2 gene
Normally functions to inhibit vascular smooth muscle prliferation |
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Term
| What is normal A-a gradient? What would cause it to increase? |
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Definition
10-15 mmHg
Increased in hypoxemia, shunting, V/Q mismatch, fibrosis (diffusion block)
NOT increased in hypoventilation! |
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Term
| What happens to the V/Q with exercise? |
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Definition
| increased CO and vasodilation of apical capillaries so get V/Q that approaches 1 |
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Term
| What are the differences in arterial, alveolar and venous pressure at the different parts of the lung? |
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Definition
Apex (zone 1): PA>Pa>Pv
zone 2: Pa>PA>Pv
Base (zone 3): Pa>Pv>PA |
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Term
| How are ventilation and perfusion different at the base and apex of the lung? |
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Definition
Both vent and perfusion are greater at the base than at the apex
Apex: V/Q = 3
Base: V/Q = 0.6 |
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Term
| What is the Haldane effect? How does it compare to the Bohr effect? |
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Definition
In lungs, oxygenation of Hb promotes dissociation of H+ from Hb. This shifts equilibrium toward CO2 formation; therefore, CO2 is released from RBCs
In peripheral tissue, increased H+ from metabolism shifts curve right, unloading O2 (Bohr effect) |
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Term
| How can CO2 be transported to the lung? |
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Definition
Bicarb
Bound to Hb at N-term (carbaminohemoglobin) --> NOT bound to heme
Dissolved CO2 |
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Term
| What is the response of the body to high altitude? |
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Definition
| Increased vent --> resp alkalosis, increased bicarb excretion to compensate, increased EPO, increased 2,3-BPG, increased mito, hypoxic pulm vasoconstriction --> RVH (and pulm HTN) |
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Term
| How do gas concentrations change with exercise? |
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Definition
| No change in PaO2 and PaCO2 (b/c ventilating more to compensate), but increase in venous CO2 content |
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Term
| What are the different types of emboli? |
|
Definition
FAT BAT
Fat, Air, Thrombus, Bacteria, Amniotic fluid, Tumor |
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|
Term
|
Definition
dorsiflexion of foot --> tender calf muscle
Sign of DVT |
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Term
| What is the change in compliance w/ emphysema? |
|
Definition
increased compliance due to loss of elastic fibers
Exhale thru pursed lips to increase airway pressure and prevent airway collapse during exhalation |
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Term
| "Blue Bloater" and "Pink Puffer" refer to what? |
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Definition
blue bloater = chronic bronchitis (early hypoxemia due to shunting, late onset dyspnea)
Pink puffer = emphysema (late hypoxemia due to loss of capillary beds, early onset dyspnea) |
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Term
| How do you test for asthma? |
|
Definition
Methacholine challenge
Promotes bronchoconstriction (M3 rec) --> asthma will react to a lower dose |
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Term
| What is bronchiectasis associated with? What are patients at risk for? |
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Definition
Assoc w/ bronchial obstruction, CF, poor ciliary motility, Kartagener's
Risk of developing aspergillosis |
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|
Term
| What is the FEV1/FVC in restrictive lung disease? |
|
Definition
>80%
decreased FVC and TLC but normal/increased FEV1 |
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Term
| What are the interstitial lung diseases that can cause restrictive lung disease? |
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Definition
| ARDS, Neonatal RDS, Pneumoconioses, sarcoidosis, idiopathic pulm fibrosis, Goodpasture's, Wegener's granulomatosis (lung nodules, infiltrates), Eosinophilic granuloma (histiocytosis X - Birbeck granules!), drug tox (bleomycin, amiodarone, busulfan) |
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Term
| What different careers/locations are associated with silicosis and asbestosis? |
|
Definition
Silicosis = foundries, sandblasting, mines --> assoc w/ upper lobe and "eggshell" calcification of hilar lymph nodes
Asbestosis = shipbuilding, roofing and plumbing --> assoc w/ lower lob |
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Term
| What are the complications associated with asbestosis? |
|
Definition
Bronchogenic carcinoma (more common!)
Mesothelioma |
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Term
| Neonatal RDS can cause what b/c of low O2? What can therapy do? |
|
Definition
PDA w/ low O2 tension
Therapeutic supplemental O2 can result in retinopathy of prematurity |
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Term
| What are the risk factors for neonatal RDS? How is it treated? |
|
Definition
Risk factors = prematurity, maternal diabetes (increased insulin), C-section (decreased release fetal glucocorticoids)
Tx = maternal steroids before birth, artificial surfactant, THYROXINE |
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Term
|
Definition
trauma, sepsis, shock, gastric aspiration, uremia, acute pancreatitis or amniotic fluid embolism
STRESS! |
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Term
| What is sleep apnea associated with? |
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Definition
| Obesity, loud snoring, systemic/pulmonary HTN, arrhythmias and possibly sudden death |
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Term
| To what direction does the trachea deviate in bronchial obstruction and tension pneumothorax? |
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Definition
Toward the side of the lesion in bronchial obstruction.
Away from the side of the lesion in tension pneumothorax |
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|
Term
| What is the most common type of lung cancer? |
|
Definition
Metastasis
From breast, colon, prostate and bladder |
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Term
| Where does lung cancer metastasize to? |
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Definition
| adrenals, brain, bone, liver |
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|
Term
| What are the common complications of lung cancer? |
|
Definition
SPHERE of complications:
Superior vena cava syndrome
Pancoast's tumor
Horner's syndrome
Endocrine (paraneoplastic)
Recurrent laryngeal symptoms (hoarseness)
Effusions (pleural or pericardial) |
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Term
| What are the different types of primary lung cancer? |
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Definition
| Squamous cell, Adenocarcinoma (bronchial and bronchioloalveolar), small cell, large cell, carcinoid and mesothelioma |
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Term
| What are the characteristics of squamous cell carcinoma of the lung? |
|
Definition
SMOKING related
Central
Hilar mass from bronchus; Cavitation, PTHrP
Keratin pearls and intercellular bridges |
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Term
| What are the characteristics of bronchial adenocarcinoma of the lung? |
|
Definition
Dev in site of prior pulm inflamm/injury
Most common lung cx in nonsmokers and females
clara cells --> type II pneumocytes
multiple densities on CXR |
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Term
| What are the characteristics of bronchioloalveolar adenocarcinoma of the lung? |
|
Definition
Not linked to smoking, grows along airways
can present like pneumonia
Can result in hypertrophic osteoarthropathy
Clara cells --> type II pneumocytes
multiple densities on CXR |
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Term
| What are the characteristics of small cell carcinoma of the lung? |
|
Definition
Central
Undifferentiated (very aggressive)
Assoc w/ ectopic ACTH/ADH
Responsive to chemo, but inoperable
Neuroendocrine cells --> small dark blue cells |
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|
Term
| What syndrome can small cell carcinoma be associated with? |
|
Definition
Lambert-Eaton syndrome
Autoantibodies to calcium channels --> decreased ACh release --> proximal muscle weakness |
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Term
| What are the characteristics of large cell carcinoma of the lung? |
|
Definition
Highly anaplastic undifferentiated
Poor prognosis
less responsive to chemo, can be removed surgically
Pleomorphic giants cells w/ leukocyte fragments in the cytoplasm |
|
|
Term
| What are the characteristics of carcinoid tumor of the lung? |
|
Definition
Can cause Serotonin syndrome = flushing, diarrhea, wheezing, salivation
May get tricuspid insuff, pulm stenosis and RHF from fibrous deposits in R heart valves |
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|
Term
| What are the characteristics of mesothelioma? |
|
Definition
Malignancy of the PLEURA assoc w/ asbestosis
Results in hemorrhagic pleural effusions and pleura thickening
Psammoma bodies |
|
|
Term
| What is pancoast's tumor? |
|
Definition
apical lung tumor --> allows for extensive spread
May affect cervical sympathetic plexus causing horner's syndrome
Also, shoulder pain, compression of subclavian vessels (edema) and spinal cord compression from extension to intravertebral foramina |
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|
Term
| What cancers are associated with psammoma bodies? |
|
Definition
| Papillary thyroid carcinoma, Papillary renal cell carcinoma, serous papillary ovarian adenocarcinoma, endometrial adenocarcinoma, meningioma, mesothelioma and somatostatinoma |
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Term
| What are the characteristics of lobar pneumonia. What bugs? |
|
Definition
Intra-alveolar exudate --> consolidation
S. pneumo most freq., maybe Klebsiella |
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|
Term
| What are the characteristics of bronchopneumonia? Bugs? |
|
Definition
Inflamm infiltrates from bronchioles into adj alveoli, PATCHY involving 1+ lobes
S.aureus, H.flu, Klebsiella, S. pyogenes |
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|
Term
| What are the characteristics of interstitial (atypical) pneumonia? |
|
Definition
Diffuse patchy inflamm localized to interstitial areas at alveolar walls
Involves 1+ lobes
Viruses (RSV, adenovirus), Mycoplasma, Legionella, Chlamydia, Rickettsia (Q fever) |
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Term
| What are the most common causes of pneumonia in the hospital? |
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Definition
| Klebsiella, Pseudomonas, E.coli |
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|
Term
| What are the most common causes of lung abscesses (bugs)? |
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Definition
| S. aureus, anaerobes (pseudomonas, klebsiella, proteus) |
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|
Term
| What are the 1st and 2nd generation H1 blockers? |
|
Definition
1st gen = Diphenhydramine, dimenhydrinate, chlorpheniramine
2nd gen = Loratadine, fexofenadine, desloratadine, certirizine |
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|
Term
| What are the methylxanthines? What do they do? |
|
Definition
Bronchodilation by inh phosphodiesterase (decreasing cAMP hydrolysis) Can then agonize adrenergic receptors.
Theophylline
Cardiotox, neurotox, blocks adenosine |
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|
Term
| What corticosteroids are used for asthma? |
|
Definition
Beclomethasone, prednisone
Inh syn of all cytokines, inactivates NF-kB (TF that induces prod of TNF-alpha) |
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Term
| What are the differences b/w Zileuton and Zafirlukast/montelukast? |
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Definition
Zileuton inh 5-lipoxygenase pathway (no leukotriene prod) --> Makes ZILCH
Zafirlukast/Montelukast = block leukotriene rec's |
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|
Term
| What affect does adenosine have on bronchial tone? |
|
Definition
Causes bronchoconstriction
Blocked by theophylline |
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|
Term
| What are the expectorants that can be used for asthma? |
|
Definition
Guaifenesin = expectorant
N-acetylcysteine = mucolytic, cleaves disulfide bonds w/in mucus glycoproteins (used for CF and antidote for acetaminophen OD) |
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|
Term
| What is the action of Bosentan? |
|
Definition
Tx pulm HTN
Competitively antagonizes endothelin-1 receptors decreasing pulm vasc resistance |
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Term
| What fungi or fungus-like bacteria can cause pulmonary infections? |
|
Definition
| Actinomycosis, Nocardosis, Candidiasis, Cryptococcus, Aspergillosis, Histoplasmosis, Coccidioidomycosis |
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|
Term
| What are the borders of the lungs in relation to ribs? |
|
Definition
Lung ends at (can do thoracocentesis at):
7th rib midclavicular
9th rib midaxillary
11th rib post. scapular |
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|
Term
| What are the main causes of eosinophilia? |
|
Definition
D-NAAACP
Drugs, Neoplasm, Allergy/Asthma, Addison's dz, Acute interstitial nephritis, collagen vasc dx, parasites (Loffler's eosinophilia) |
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|
Term
| How is breathing controlled? |
|
Definition
Medullary resp center --> reticular formation
Dorsal resp group = inspiration (input from CN IX and X (chemo and mechanorec))
Ventral resp group = expiration (only w/ active expir)
Apneustic center (lower pons) = stim inspiration gasp
Pneumotaxic center (upper pons) = inh inspiration
Cerebral cortex = voluntary |
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Term
| What are the sites of metastasis to the lung and site of metastasis from the lung? |
|
Definition
breast, colon, prostate and bladder --> lung --> adrenals, brain, bone, liver
(repro and GI --> lung --> endo, CNS, liver) |
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