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Pulmonary

FA complete review

QuestionAnswer
What is the mechanism of action of Histamine-1 blockers? Reversible inhibitors of H1 histamine receptors.
What are some First generation H1-blockers? Diphenhydramine, dimenhydrinate, and chlorpheniramine.
What are the clinical uses for H1-blockers? Allergy, motion sickness, and sleep aid
What are common side effects of H1-blockers? Sedation, antimuscarinic, anti-alpha-adrenergic.
What are some examples of Second generation H1-blockers? Loratadine, fexofenadine, desloratadine, cetirizine.
What is the main use for H1-blockers of second generation? Allergy
Why are second generation far less sedating than 1st generation H1-blockers? Less entry into CNS
Common expectorant? Guaifenesin
What is N-acetylcysteine? Mucolytic- liquifies mucus in chronic bronchopulmonary diseases by disrupting disulfide bonds.
N-acetylcysteine is used for antidote for ____________________ overdose. Acetaminophen
What is Dextromethorphan mechanism of action? Antitussive; antagonizes NMDA glutamate receptors; Synthetic codeine analog.
How can Dextromethorphan overdose treated? Naloxone
What is a significant adverse effect of Dextromethorphan? Serotonin syndrome if combined with other serotonergic agents.
What is the mechanism of action of Pseudoephedrine and Phenylphrine? a-adrenergic agonists, used as nasal decongestants
What are the clinical uses for Pseudoephedrine and phenylephrine? 1. Reduce hyperemia, edema, and nasal congestion 2. Open obstructed eustachian tubes
What are the most significant adverse effects of Pseudoephedrine and phenylephrine? 1. Hypertension 2. Rebound congestion if used more than 4-6 days 3 CNS stimulation/anxiety (pseudoephedrine)
What drug categories are used in the treatment of Pulmonary hypertension? 1. Endothelin receptor antagonists 2. PDE-5 inhibitors 3. Prostacyclin analogs
What is the MOA of Endothelin receptor antagonists? Competitively antagonizes endothelin-1 receptors --> decrease in pulmonary vascular resistance
Which endothelin receptor is blocked by Endothelin-receptor blockers? Endothelin-1
What is the most common example of an Endothelin-receptor antagonist? Bosentan
Bosentan is an _______________________________. Endothelin-receptor antagonists
What is the associated adverse effect of Bosentan? Hepatotoxic (monitor LFTs)
What is the MOA of PDE-2 inhibitors? Inhibits PDE-5 --> Increase in cGMP, which as result causes prolonged vasodilatory effect of NO (nitric monoxide).
Besides management of Pulmonary HTN, another common use for PDE-5 inhibitors is _____________________. Erectile dysfunction
What drugs/compounds are contraindicated in a patient on PDE-5 inhibitors? Nitroglycerin or other nitrates
What is the most common example of PDE-5 inhibitor? Sildenafil
What are the examples of Prostacyclin analogs? Epoprostenol, iloprost
MOA of Prostacyclin analogs -PGI2 (prostacyclin) with direct vasodilatory effects on pulmonary and systemic arterial vascular beds - Inhibits platelet aggregation.
What are the most common side effects of Prostacyclin analogues? Flushing and jaw pain
Asthma therapy is directed to counteract which two processes of Bronchoconstriction? 1. Inflammatory processes 2. Parasympathetic tone
Short acting B2 agonist Albuterol
What are 3 common B2-agonists used in Asthma treatment? Albuterol (short acting), Salmeterol, and formoterol
What is the common B2-agonist used in acute exacerbation of asthma? Albuterol
What is MOA of Albuterol? Relaxes bronchial smooth muscle in acute setting.
Which B-2 agonists are commonly used a prophylaxis of Asthma? Salmeterol and Formoterol
What are common adverse effects of Salmeterol? Tremor and arrhythmias
Examples of common inhaled corticosteroids? Fluticasone and Budesonide
What Asthma drugs are known to inhibit the synthesis of virtually all cytokines? Inhaled corticosteroids (fluticasone, budesonide)
What drug(s) are the first line of treatment for chronic asthma ? Inhaled corticosteroids (fluticasone, budesonide)
What is the mode action of Fluticasone? Inactivate NF-KB
What is the function of NF-KB? Transcription factor that induces production of TNF-alpha and other inflammatory agents
What transcription factor is inactivated by inhaled corticosteroids, such as Fluticasone? NF-KB
What actions must be taken in order to prevent oral thrush formation from the use of Fluticasone and other inhaled corticosteroids? Use a spacer or rinse mouth after use
Which are two common Muscarinic antagonists? Tiotropium and Ipratropium
What is the MOA of Muscarinic antagonist? Competitively block muscarinic receptor, preventing bronchoconstriction.
Tiotropium and Ipratropium are ______________ _______________. Muscarinic antagonists
Which muscarinic antagonist is used in treatment of asthma and is known to be long-acting? Tiotropium.
3 common antileukotrienes: Montelukast, Zafirlukast, and ZIleuton
Which antileukotrienes block leukotriene receptors CysLT1? Montelukast and Zafirlukast
What are the recommended asthma drugs for Aspirin-induced asthma and Exercise-induced asthma? Montelukast and Zafirlukast
Montelukast and Zafirlukast are _______________________-. Antileukotrienes
5-lipoxygenase pathway inhibitor. Zileuton
What is blocked by the use of Zileuton? Conversion of arachidonic acid to leukotrienes
Which antileukotriene is known to be hepatotoxic? Zileuton
What is Omalizumab? Anti-IgE monoclonal antibody in the treatment of asthma
What is the mode of action of Omalizumab? Binds unbound serum IgE and blocks binding to FcERI
What type of asthma is the one that most commonly uses Omalizumab as part of drug therapy? Allergic asthma with elevated IgE levels resistant to inhaled steroids and long-acting B2-agonist
Patient's asthma proven ineffective treatment with inhaled steroids and Salmeterol, may be given _______________ as therapy for asthma. Omalizumab
Theophylline is a __________________________. Methylxanthine
How does Theophylline causes bronchodilation? By inhibiting phosphodiesterase --> elevated cAMP levels due to decreased cAMP hydrolysis
Why is the use of Theophylline limited? Due cardiotoxicity and neurotoxicity
Theophylline blocks actions of _______________. Adenosine
Theophylline is metabolized by the ________________________. CYP450 system.
What are common examples of Mast cell stabilizers? Cromolyn and nedocromil
Mechanism of action of Mast cell stabilizers Prevent release of inflammatory mediators from mast cells
What is the main use for mast cell stabilizers? Prevention of bronchospasm
Which Asthma drugs are used to prevent/treat symptoms? 1. B-agonists 2. Theophylline 3. Muscarinic antagonists
Which Anti-asthmatic drugs are used for prevention or treatment of bronchial hyperreactivity? Studies and Antileukotrienes
What is the early response of asthma process? Bronchoconstriction --> symptoms
What is the late response of asthma? Inflammation --> bronchial hyperreactivity.
What is rhinosinusitis? Obstruction of sinus drainage into nasal cavity leading to inflammation and pain over affected area.
What sinuses are most affected by rhinosinusitis? Maxillary sinuses, which drain against gravity due to ostia located superomedial.
What is the most common cause of Rhinosinusitis? Viral URI
In cases that rhinosinusitis affect the sphenoid or ethmoid sinuses, may lead to ----> Cavernous sinus syndrome
Clinical term of nosebleed? Epistaxis
What is most common location of developing Epistaxis? Kiesselbach plexus
What is the Kiesselbach plexus? Anterior segment of nostril
What arterial body may cause a fatal epistaxis? Sphenopalatine artery, a branch of maxillary artery
What are the arteries are involved in the Kiesselbach plexus? -Superior Labial artery - Anterior and Posterior Ethmoidal arteries -Greater palatine artery - Sphenopalatine artery
What kind of cancer is most common in head and neck? Squamous cell carcinoma
Blood clot within a deep vein. Dx? DVT (deep venous thrombosis)
What are most common symptoms /signs of DVT? Swelling, redness, and pain
What codition is associted to Virchow triad? DVT (deep venous thrombosis)
What are the components of Virchow triad? 1. Stasis 2. Hypercoagulability 3. Endothelial damage
What kind of lab test is done to rule out DVT? D-dimer
Where do most pulmonary emboli arise from? Proximal deep veins of lower extremity
What is the most common treatment for DVT? Unfractionated heparin or low-molecular-weight heparins
What is the most common drug used for long-term treatment for DVT? Warfarin
What is the exam/imaging test for DVT? Compression ultrasound with Doppler.
A pulmonary emboli causes: V/Q mismatch, hypoxemia, and respiratory alkalosis
What are the clinical signs of PE? Sudden-onset dyspnea, pleuritic chest pain, tachypnea, and tachycardia
What are Lines of Zahn? Interdigitating areas of pink and red found only in thrombi formed before death
What feature can be used to distinguish between pre- and post mortem thrombi? Lines of Zahn
What are the most common types of thrombi? Fat, Air, Thrombus, Bacteria, Amniotic fluid, and Tumor
What are conditions associated with fat emboli? Long bone fractures and liposuction
What is the classic triad of fat emboli? Hypoxemia, neurologic abnormalities, and petechial rash
What kind of sport or aquatic event is associated with air emboli? Ascending divers
What are the pathologies associated with air emboli? Caisson disease/ Decompression sickness
What is the most severe complication of an amniotic fluid emboli? DIC
What is the imaging test of choice for PE? CT pulmonary angiography
What is the associated ECG abnormality with a PE? S1Q3T3
S1Q3T3. Dx? Pulmonary embolism
What are the 3 Flow-Volume parameters DECREASED in Obstructive lung disease? Greatly FEV1, and mild reductions in FVC, which together lead to a mild decrease in FEV1/FVC.
Which is most decreased, FEV1 or FVC, in obstructive lung disease? FEV1
The loop in a Flow-Volume lung graph, is shifted to which side in Obstructive lung disease? Left shifted
Obstructive lung disease have ________ shift on Flow-Volume graph. Left
What are the 3 parameters increased in Obstructive lung disease? RV, FRC, and TLC.
FEV1 is decreased proportionately to FVC Restrictive lung disease
How is he FEV1/FVC in the restrictive lung disease profile? Normal or mildly increased
Restrictive lung disease have all parameters __________________. Decreased
A grater FEV1 decrease is seen in _______________ lung disease. Obstructive
A right shift of the loop in a flow-volume loop graph is seen with ______________________________ diseases. Restrictive lung disease
Loop shifts to the right Restrictive lung disease
Loop shifts to the left Obstructive lung disease
Which lung profile describes obstruction of air flow leading to air trapping in lungs? Obstructive lung disease
Airways close prematurely at high lung volumes? Obstructive lung disease
What is the hallmark of Obstructive lung disease with respect to PFTs? Decreased FEV1/FVC
What is the most severe consequence of chronic, hypoxic pulmonary vasoconstriction seen in Obstructive lung diseases? Cor pulmonale
What are the types of Obstructive lung diseases? 1. Chronic bronchitis 2. Emphysema 3. Asthma 4. Bronchiectasis
Common way to refer to a person with Chronic bronchitis? "Blue bloater"
What are the findings of chronic bronchitis? Wheezing, crackles, cyanosis, dyspnea, CO2 retention, and secondary polycythemia
Reason of clinical cyanosis in chronic bronchitis patients? Hypoxemia due to shunting
Which type of obstructive lung disease is seen with secondary polycythemia? Chronic bronchitis
Reid index > 50%. Dx? Chronic bronchitis
How is the DLCO in a "blue bloater"? Normal
Hypertrophy and hyperplasia of mucus-secreting glands in bronchi. Dx? Chronic bronchitis
What is the Reid index? Thickness of mucosal gland layer to thickness of wall between epithelium and cartilage.
Diagnostic criteria for Chronic bronchitis? Productive cough for > 3 months in a year for > 2 consecutive years.
What is the refer term used for a emphysema patient? "Pink puffer"
"Pink puffer". Dx? Emphysema
What are the classical findings and/or presentation of a patient with emphysema? - Barrel-shaped chest, - Exhalation through pursed lips
A patient that breathes through pursed lips. Dx? Emphysema
What is the reason for emphysema patients to breath through pursed lips? Increased airway pressure and prevents airway collapse
How is airway collapse often prevented by emphysematic patients? Breath through pursed lips
What type of emphysema is associated with smoking? Centricacinar
What are the two main types of Emphysema? Centriacinar and Panacinar
Which lobes are most likely to be affected by Centriacinar emphysema? Upper lobes
Upper lobes usually develop __________________ emphysema. Centriacinar
What is the most common condition associated with development of Panacinar emphysema? Alpha-1-antitrypsin deficiency
Which lobes, upper or lower, are often where Panacinar emphysema develops? Lower lobes
a-1 antitrypsin deficiency develops _________________________ (respiratory). Panacinar emphysema
Which Obstructive lung condition is seen with: enlargement of air spaces, decreased recoil, increases compliance, and decreased DLCO ? Emphysema
What obstructive lung disorder is associated with smoking? Centriacinar emphysema
What are the findings or features seen in CXR of a patient with emphysema? Increased AP diameter, flattened diaphragm, and increase lung lucency.
Why is DLCO decreased in emphysema? Due to destruction of alveolar walls
What is the initial insult or reason for increased in lung compliance in an patient with emphysema? Imbalance of proteases and antiproteases, which lead to an increase in elastase activity leading to increase loss of elastic fibers
What is the classic clinical presentation and features of Asthma? Cough, wheezing, tachypnea, dyspnea, hypoxemia, decreased inspiratory/expiratory ratio, pulsus paradoxus, and mucus plugging
What are some of the MC triggers for Asthma? URIs, allergens, and stress.
What are supporting tests for diagnosing Asthma? Spirometry and methacholine challenge
A person that recalls having done the Methacholine challenge, is suspected to have? Asthma
What condition is often diagnosed by supporting evidence of a Methacholine challenge? Asthma
Hyperresponsive bronchi. Dx? Asthma
Asthma is considered what type of Hypersensitivity? Type 1
What is Aspirin-induced asthma? A combination of COX inhibition , chronic sinusitis with nasal polyps, and asthma symptoms
COX inhbition causes --> Leukotriene overproduction which causes airway constriction
What condition is associated with Curschmann spirals? Asthma
What are Curschmann spirals? Shed epithelium forms whorled mucous plugs
Eosinophilic, hexagonal, double-pointed crystals formed from breakdown of eosinophils in sputum. Charcot-Leyden crystals
Charcot-Leyden crystals + Curschmann spirals. Dx? Asthma
DLCO in Asthma: Normal or mildly increased
What changes are seen in smooth muscle in a person with Asthma? Hypertrophy and hyperplasia
What are important or key features found in sputum examination of asthmatic patient? Curschmann spirals, Charcot-Leyden crystals, and smooth muscle hypertrophy and hyperplasia.
Nasal polyps + asthma symptoms + sinusitis. MC Dx? Aspirin-induced asthma
Common presentation and findings of Bronchiectasis? Purulent sputum, Recurrent infections Hemoptysis Digital clubbing
Chronic necrotizing infection of bronchi or obstruction leading to permanently dilated airways. Pathology of Bronchiectasis
How are the airways in Bronchiectasis? Permanently dilated
What are some associations to Bronchiectasis? Bronchial obstruction, poor ciliary motility, cystic fibrosis, allergic bronchopulmonary aspergillosis.
What is a common AR disease associated with Bronchiectasis? Cystic fibrosis
What is a common obstructive lung disease associated with Kartagener syndrome? Bronchiectasis
What kind of aspergillus-associated condition is seen in a patient with Bronchiectasis? Allergic bronchopulmonary aspergillosis
What are the two types of Restrictive lung diseases? 1. Poor breathing mechanics 2. Interstitial lung diseases
Describe the main/overall features of Restrictive lung diseases due to poor breathing mechanics? Extrapulmonary, peripheral hypoventilation, and a normal A-a gradient.
Which are the two main reasons for poor breathing mechanics producing a restrictive lung profile? Poor muscular effort and poor structural apparatus
Examples of conditions/pathologies that cause a restrictive lung profile due to poor breathing mechanics caused by poor muscular effort? Polio, Myasthenia gravis, and Guillain-Barre
What type of Restrictive lung disease category would Scoliosis and morbid obesity be part of? Poor structural apparatus leading to poor breathing mechanics
What is seen as main features of all Interstitial lung diseases? Pulmonary condition with decreased diffusing capacity and a increased A-a gradient.
If the restrictive lung condition shows an increase in A-a gradient, it indicates : An interstitial lung disease
What are some (list) of examples of Interstitial lung diseases? 1. Pneumoconiosis 2. Sarcoidosis 3. Idiopathic pulmonary fibrosis 4. Goodpasture syndrome 5. Granulomatosis with polyangiitis (Wegener) 6. Pulmonary Langerhans cell histiocytosis (Eosinophilic granuloma) 7. Hypersensitivity pneumonitis 8. Drug toxicity
Examples of Pneumoconiosis? Coal workers' pneumoconiosis, silicosis, asbestosis
What are some key features of Sarcoidosis? - Bilateral hilar lymphadenopathy - Noncaseating granuloma - Increased ACE and Ca2+
What is Idiopathic pulmonary fibrosis? Repeated cycles of lung injury and wound healing with increased collagen deposition, "honeycomb" lung appearance and digital clubbing
A lung tissue that is constantly damage by irritant and in the same way it is healed, leads to the development of what restrictive lung condition? Idiopathic pulmonary fibrosis
Which Interstitial lung diseases is described often with lung with a "honeycomb" appearance and digital clubbing? Idiopathic pulmonary fibrosis
What are some drugs which toxicity cause Interstitial lung disease, thus a restrictive lung profile? Bleomycin, Busulfan, Amiodarone, and Methotrexate.
What type(s) of hypersensitivity is hypersensitivity pneumonitis? Mixed type III/IV hypersensitivity reaction
What population is often seen with Hypersensitivity pneumonitis? Farmers and those exposed to birds
Immune-mediated condition, widespread noncaseating granulomas, elevated serum ACE levels, and elevated CD4+/CD8+ ratio in bronchoalveolar lavage fluid. Dx? Sarcoidosis
Who is most likely to be affected by Sarcoidosis? African-American females
Sarcoidosis is mostly asymptomatic, except for: Enlarged lymph nodes
What are the common CXR finding in Sarcoidosis? Bilateral adenopathy and coarse reticular opacities
What are important associated conditions of Sarcoidosis? 1. Bell palsy 2. Uveitis 3. Noncaseating granulomas 4. Lupus pernio 5. Interstitial fibrosis 6. Erythema nodosum 7. Rheumatoid arthritis-like arthropathy 8. Hypercalcemia
What is the treatment for symptomatic Sarcoidosis? Steroids
What is Lupus pernio? Associated condition of Sarcoidosis, characterised as skin lesions on face resembling lupus
Description of granulomas found/associated with Sarcoidosis? Epithelioid, containing microscopic Schaumann and asteroid bodies; Noncaseating
Noncaseating granulomas. Dx? Sarcoidosis
What is a common finding in physical examination of a patient with an inhalation injury? Singed nasal hairs
What are findings in bronchoscopy of a inhalation injury patient? Severe edema, congestion of bronchus, and soot deposition
How many days take for resolution from an inhalation injury? 11 days
Which part of the lungs are most prone to be affected by Asbestos? Lower lobes
Silica and coal affect the ____________ lobes of the lung. Upper
What are the associated jobs/ professions that incrase Asbestos exposure? Shipbuilding, roofing, and plumbing.
What are the pathognomonic features of Asbestosis? "Ivory white", calcified supradiaphragmatic and pleural plaques.
Asbestosis causes increased risk of ________________________ carcinoma more than Mesothelioma. Bronchogenic
Lobes affected by Asbestosis? Lower lobes
What are the characteristic histological findings of Asbestosis? Ferruginous bodies
What type of exposure leads to appearance of Ferruginous bodies? Asbestos
What are Ferruginous bodies? Golden-brown fusiform rods resembling dumbbells, found in alveolar sputum sample.
What type of stain is used to visualize Ferruginous bodies in Asbestosis? Prussian blue stain
Prussian blue stain + lower lobes plaques. Dx? Asbestosis
What histological compound is known to resemble dumbbells? Ferruginous bodies in Asbestosis
What environments can have exposure to Beryllium most commonly? Aerospace and manufacturing industries
How are the granulomas seen in Berylliosis? Noncaseating
Which lung lobes are affected by Berylliosis? Upper lobes
What conditions is associated with prolonged coal dust exposure? Coal Workers' pneumoconiosis
Which lobes of the lung are affected by Coal workers' pneumoconiosis? Upper lobes
Which pneumoconiosis is seen with macrophages laden with carbon? Coal Workers' pneumoconiosis
What is another name for Coal Workers' pneumoconiosis? Black lung disease
What condition is at increased risk of development with Black lung disease? Caplan syndrome
What is Caplan syndrome? Rheumatoid arthritis and pneumoconiosis with intrapulmonary nodules
Caplan syndrome is often develop after the patient had: Coal Workers' pneumoconiosis
Small, rounded nodular opacities seen in Upper lung lobes imaging? Coal Workers' pneumoconiosis
What is Anthracosis? Asymptomatic conditions found in many urban dwellers exposed to sooty air.
"Eggshell" calcification of hilar lymph nodes on CXR. Dx? Silicosis
Which jobs are associated with Silicosis? Sandblasting, foundries, and mines
What condition may be reactivated in patients with Silicosis? TB
What are associated risks of developing in a Silicosis patient? Cancer, cor pulmonale, and Caplan syndrome
Which lobes of the lungs are most affected by Silicosis? Upper lobes
Which is the only pneumoconiosis that affects the lower lobes of the lung? Asbestosis
What is Mesothelioma? Malignancy of the pleura associated with asbestosis. It may result in hemorrhagic pleural effusion (exudative), pleural thickening.
What is a common marker in almost all mesotheliomas? Calretinin
Smoking is not a risk factor for ________________________ development. Mesothelioma
Alveolar insult leading to proinflammatory cytokine release and eventually to leakage of protein-rich fluid into alveoli, leading to development of intra-alveolar hyaline membranes. Dx? Acute respiratory distress syndrome (ARDS)
What is the criteria used to diagnose, by exclusion, ARDS? - Abnormal CXR (bilateral lung opacities) - Respiratory failure within 1 wk of alveolar insult - Decreased PaO2/FiO2 ratio <300 - Symptoms of respiratory failure are not due to HF/fluid overload
Why is mechanical ventilation used in ARDS? Decreased tidal volumes, and to Increase PEEP
What are the consequences of ARDS? - Impaired gas exchange - Decreased lung compliance - Pulmonary hypertension
What is sleep apnea? Repeated cessation of breathing > 10 seconds during sleep.
What are consequences of Nocturnal hypoxia seen in sleep apnea? Systemic/pulmonary hypertension, arrhythmias, and sudden death
The hypoxia caused in sleep apnea causes ----> Increase EPO release which leads to increased erythropoiesis.
Respiratory effort against airway obstruction. Obstructive sleep apnea
What are associations to of Obstructive sleep apnea? Obesity, loud snoring, and daytime sleepiness
Why do adults develop OSA? Excess parapharyngeal tissue
What is the reason children develop OSA? Adenotonsillar hypertrophy
What is Central sleep apnea? Impaired respiratory effort due to CNS injury/toxicity, HF, opioids.
What is a characteristic breathing pattern seen in Central sleep apnea? Cheyne-Stoke respirations
What is the treatment for Central Sleep apnea? Positive airway pressure
What are Cheyne-Stokes respirations? Oscillations between apnea and hyperpnea.
What is another name for Obesity hypoventilation syndrome? Pickwickian syndrome
What are the arterial pressure changes of Oxygen and CO2 in Obesity hypoventilation syndrome during sleep? Decrease in PaO2 Increase in PaCO2
Hypoventilation in an obese person causes what changes to PaCO2 during waking hours? Increased PaCO2 due to retention
What is the normal mean pulmonary artery pressure? 10-14 mm Hg
At what pressure (mm Hg) is pulmonary hypertension diagnosed? > or equal to 25 mm Hg at rest
What are the consequences of Pulmonary hypertension? Arteriosclerosis, medial hypertrophy, intimal fibrosis of pulmonary arteries, and plexiform lesions.
What mutation causes hereditary form of Pulmonary arterial hypertension (PAH)? Inactivating mutation in BMPR2
What are the pulmonary vascular endothelial dysfunction results? Increase of Vasoconstrictors and decrease of Vasodilators.
What are etiologies (causes) of Pulmonary hypertension? 1. Pulmonary arterial hypertension 2. Left heart disease 3. Lung diseases or hypoxia 4. Chronic thromboembolic 5. Multifactorial
Why is Pulmonary HTN is caused by thrombotic events? Recurrent microthrombi leading decreased cross-sectional area of pulmonary vascular bed
What lung conditions are seen with Hyperresonant percussion upon PE? Simple pneumothorax and Tension pneumothorax
What lung condition is seen with increased fremitus? Consolidation
What pathologies cause consolidation? Lobar pneumonia and pulmonary edema
Atelectasis has tracheal deviation to: Toward side of lesion
Tracheal deviation in Tension pneumothorax is to: Away from side of lesion
If the trachea is deviated toward the affected side, which is the most common reason? Atelectasis (bronchial obstruction)
Which pathologies or lung conditions demonstrate a tracheal deviation away from the side of injury? Pleural effusion and Tension pneumothorax
What are pleural effusions? Excess accumulation of fluid between pleural layers which produced a restrictive lung expansion during inspiration.
Is inspiration or exhalation, affected by pleural effusions? Inspiration
What is a common treatment option for Pleural effusions? Thoracentesis
What are the main types of pleural effusions? Transudate, Exudate, and lymphatic
Which pleural effusion type is seen with decreased protein content? Transudate
Transudate effusions are due to: 1. Increase in hydrostatic pressure (HF) or, 2. Decrease in Oncotic pressure (nephrotic syndrome, cirrhosis)
An increase in hydrostatic pressure will produce ______________ (pleural effusion). Transudate
What is a common pathology that leads to an increase in hydrostatic pressure? Heart failure
A person with heart failure, will likely develop fluid in the lung pleural, which is known as ________________. Transudate
What kind of pressure is decreased in nephrotic syndrome and cirrhosis that produce transudate? Oncotic pressure
In transudate production, the hydrostatic pressure is _____________, and the oncotic pressure is _______________. Increased; Decreased
Pleural effusion rich in protein content, and cloudy. Exudate
Exudate is due to: Malignancy, pneumonia, collagen vascular disease, trauma
Exudate occurs in states of: Increased vascular permeability
Which type of pleural effusion imposes increased risk to infection? Exudate
If the fluid extracted from the lung pleura is cloudy, it is classified as _______________. Exudate
What is another name given to lymphatic pleural effusions? Chylothorax
What is produced by trauma or malignancy of/to Thoracic duct? Chylothorax or Lymphatic pleural fluid
Milky-appearing fluid Chylothorax or Lymphatic pleural fluid
What serum condition is often associated with Chylothorax development? Increased triglycerides
What is a Pneumothorax? Accumulation of air in pleural space
What classic signs and symptoms of Pneumothorax? Dyspnea, and uneven chest expansion
Abnormalities on lung auscultation, pain, etc are in the ____________ side of the pneumothorax. Ipsilateral
What is the most common cause for Primary spontaneous pneumothorax? Rupture of apical subpleural bleb or cyst
What type of pneumothorax is expected in a tall, thin, smoker, young male? Primary spontaneous pneumothorax
The sudden rupture of a pleural bleb or cyst is the MCC of? Primary spontaneous pneumothorax
What are the MCC of secondary spontaneous pneumothorax? - Diseased lung ( bullae in emphysema, infections) - Mechanical ventilation with ouse of high pressures --> barotrauma
What type of pneumothorax is often due to blunt trauma to the chest/thorax? Traumatic pneumothorax
A person just received a gunshot, it is probably to develop what kind of pneumothorax? Traumatic pneumothorax
What is the key feature of a Tension pneumothorax? Air enters pleural space but cannot exit.
List of types of Pneumonia: 1. Lobar pneumonia 2. Bronchopneumonia 3. Interstitial (atypical) pneumonia 4. Cryptogenic organizing pneumonia
What are the characteristics of Lobar pneumonia? 1. Intra-alveolar exudate (protein rich) ---> CONSOLIDATION 2. May involve entire lobe or the whole lung
What is the MCC of Lobar pneumonia? S. pneumoniae
What are two less common organisms that are known to produce lobar pneumonia? Legionella and Klebsiella
What are the characteristics of Bronchopneumonia? 1. Acute inflammatory infiltrates from bronchioles into adjacent alveoli . PATCHY distribution involving 1 or more lobes.
What kind of pneumonia is seen with Patchy distribution in CXR? Bronchopneumonia
What are the most common organisms causing Bronchopneumonia? S. pneumoniae, S. aureus, H. influenzae, and Klebsiella
Another way to name or refer to an atypical pneumonia? Interstitial
What are some of the MC organisms causing Interstitial (atypical) pneumonia? Mycoplasma, Chlamydophila pneumoniae, Chlamydophila psittaci, Legionella, viruses (RSV, CMV, influenza, adenovirus)
Which type of pneumonia is seen with Diffuse patchy inflammation localized to interstitial areas at alveolar walls? Interstitial (atypical) pneumonia
What are the key features of Atypical pneumonia? 1. Diffuse patchy inflammatoin localized to interstitial areas at alveolar walls 2. Diffuse distribution involving more than 1 lobe 3. Follow an indolent course
"Walking pneumonia" Interstitial (atypical) pneumonia
What is the old name for Cryptogenic organizing pneumonia? Bronchiolitis Obliterans organizing pneumonia (BOOP)
Noninfectious pneumonia characterized by inflammation of bronchioles and surrounding structure. Cryptogenic organizing pneumonia
What type of pneumonia is known to be caused by chronic inflammatory diseases or medication side effects? Cryptogenic organizing pneumonia
What are the 4 stages of Lobar pneumonia (in order of appearance)? 1. Congestion 2. Red hepatization 3. Gray hepatization 4. Resolution
Congestion phase of lobar pneumonia is during days ____________. 1-2
What are important finding of Congestion stage of Lobar pneumonia? - Red-purple, partial consolidation of parenchyma - Exudate with mostly bacteria
Consolidation pneumonia = Lobar pneumonia
At what stage of lobar pneumonia is it described as "Red-brown, consolidated"? Red hepatization
What is found in exudate of lobar pneumonia at the Red hepatization stage? Fibrin, bacteria, RBCs, and WBCs.
Uniformly gray lobe affected in lobar pneumonia, is a finding of? Gray hepatization of Lobar pneumonia
Gray hepatization stage occurs in days ________. 5-7
What is the most common clinical presentation of Lung cancer? Cough, hemoptysis, bronchial obstruction, wheezing, pneumonic "coin" lesion on CXR or noncalcified nodule on CT.
What is characteristic description of lung cancer in an CXR? "Coin" lesion
What are the most common complications of Lung cancer? Superior vena cava/thoracic outlet syndromes Pancoast tumor Horner syndrome Endocrine (Paraneoplastic) Recurrent laryngeal nerve compression (hoarness) Effusions (pleural or pericardial)
What are the most important risk factors for developing Lung cancer? Smoking, secondhand smoke, radon, asbestos, and family history.
Which lung cancer are central? Squamous cell carcinoma and Small cell carcinoma
Squamous and Small cell carcinomas of the lung are most often caused by ___________________. Smoking.
Oat cell carcinoma is the same as: Small cell carcinoma of the lung
Which is the most aggressive type of lung cancer? Small cell carcinoma of the lung
What are some possible complications or results from Small cell carcinoma of the lung? 1. ACTH production ---> Cushing syndrome 2. SIADH 3. Antibodies against presynaptic Ca2+ channels --> Lambert-Eaton myasthenic syndrome. 4. Antibodies against neurons --> Paraneoplastic myelitis, encephalitis, subacute cerebellar degeneration.
Which type of lung cancer is known to cause Lambert-Eaton myasthenic syndrome? Small cell carcinoma of the lung
Which oncogene is known to be amplified in Small cell carcinoma of the lung? myc
Neoplasm of Neuroendocrine Kulchitsky cells? Small cell carcinoma of the lung
What are (+) markers for Small cell carcinoma of the lung? - Chromogranin A - Neuron-specific enolase - Synaptophysin
Histological view of a lung cancer depicts small dark blue cells and positive for Chromogranin A serum marker. Dx? Small cell carcinoma of the lung
Which are the non-small cell lung cancer types? 1. Adenocarcinoma 2. Squamous cell carcinoma 3. Large cell carcinoma 4. Bronchial carcinoid tumor
What is the most common primary lung cancer? Adenocarcinoma of the lung
Which gender is more prone to developing Lung adenocarcinoma? Women
Which kind of non-small lung cancer is seen in nonsmokers? Adenocarcinoma of the lung
Female, nonsmoker. What kind of lung cancer is she most likely to develop? Adenocarcinoma of the lung
What are the associated activating mutations of lung adenocarcinoma?l KRAS, EGFR, and ALK
What is an important physical association of Lung adenocarcinoma? Hypertrophic osteoarthropathy (clubbing)
Which type of lung cancer is seen with clubbing? Adenocarcinoma of the lung
What type of lung cancer is seen histologically as: Glandular pattern, often stains mucin (+)? Adenocarcinoma of the lung
Mucin (+) lung cancer Adenocarcinoma of the lung
What is the subtype of Adenocarcinoma of the lugn? Bronchioloalveolar
Description of Bronchioloalveolar subtype lung cancer Grown along alveolar septa --> apparent "thickening" of alveolar walls. Tall, columnar cells containing mucus
Hilar mass arising from bronchus. Most likely lung cancer type? Squamous cell carcinoma
What are the associated C's of Squamous cell lung carcinoma? Central Cavitation Cigarettes hyperCalcemia
What substance produces the hypercalcemia seen in Squamous cell lung carcinoma? PTHrP
What are the key histological findings in Squamous cell lung carcinoma? Keratin pearls and intercellular bridges
Which lung cancer type is seen with "Keratin pearls" in histology? Squamous cell carcinoma of the lung
Pleomorphic giant cells. Histological description of which type of lung cancer? Large cell carcinoma of the lung
Highly anaplastic undifferentiated tumor. Peripherally located, with a strong association to smoking? Large cell carcinoma of the lung
Location of Bronchial Carcinoid tumor Central or peripheral
Which lung cancer type symptoms include mass effect or carcinoid syndrome ? Bronchial carcinoid syndrome
What are histological features of Bronchial carcinoid tumor? Nests of neuroendocrine cells Chromogranin A (+)
Air-fluid levels seen on CXR Lung abscesses
What is a lung abscess? Localized (lung) collection of pus within parenchyma
What are the two most important causes of Lung abscess formation? 1. Aspiration of oropharyngeal contents 2. Bronchial obstruction
The presence of lung abscess suggest also the presence of : Cavitation
MC organism causative of lung abscesses? 1. Anaerobes (Bacteroides, Fusobacterium) 2. S. aureus
Which lung is more likely to develo lung abscess secondary to aspiration? Right lung
What kind of patients are most prone to develop lung abscess due to aspiration? Patients predisposed to loss of consciousness (alcoholics, epileptics).
What is another term for Pancoast tumor? Superior sulcus tumor
Carcinoma that occurs in the apex of lung and causes Pancoast syndrome by invading the cervical sympathetic chain? Pancoast tumor
What neurological structure is invaded by Pancoast syndrome? Cervical Sympathetic chain
What are some findings of Pancoast tumor compression of locoregional structures? 1. Recurrent laryngeal nerve ---> Hoarseness of voice 2. Stellate ganglion --> Horner syndrome 3. Superior vena cava ---> SVC syndrome 4. Brachiocephalic vein --> Brachiocephalic syndrome 5. Brachial plexus --> sensorimotor deficits
What structure is compressed by Pancoast tumor to produce the ipsilateral Horner syndrome? Stellate ganglion
What are the constellation of symptoms that make up Horner syndrome? Ipsilateral ptosis, miosis, and anhidrosis
Obstruction of the SVC that impairs blood drainage from the head, neck, and upper extremities. Dx? Superior vena cava (SVC) syndrome
What are the head deficits seen in SVC syndrome? "Facial plethora"
Facial plethora, common feature of ____________________. Superior vena cava (SVC) syndrome
What re the MCC of SVC syndrome? 1. Malignancy (mediastinal mass, Pancoast tumor) 2. Thrombosis from indwelling catheters
WHat is an important complication of SVC syndrome? Increase in ICP --> increase risk of aneurysm/ rupture of intracranial arteries
What nerve is compressed, usually and commonly by malignancies, to cause development of hoarseness of voice? Recurrent laryngeal nerve
Hoarseness of voice is commonly due to? Compression of recurrent laryngeal nerve
In lung volume terms, a capacity is: The sum of at least 2 or more physiologic volumes
What is the inspiratory reserve volume? Air that can still be breathed in after normal inspiration
What is the the term used for the amount of air that can be breathed in or inspired after a normal inspiration? Inspiratory reserve volume
What is the tidal volume? Air that moves into lung with each quite inspiration
What i sthe normal or most common value of Tidal volume? 500 mL
A person with a _________ mL tidal volume is consider normal. 500
Deficinot of Expiratory reserve volume Air that can still be breathed out after normal expiration
In lung volume terminology the word "reserve" is used to describe: Amount of air that can be still be inspired or expired after NORMAL, inspiration or exahalation, respectively.
What is the residual volume? Air in lung after maximal expiration
What lung volume is the one that describes air left in lung after a person performs a maximal expiration? Residual volume
RV or any lung capacity that includes RV cannot be measured by ____________. Spirometry
What lung volume causes inability to measures lung volumes with Spirometry? Residual volume
IRV + TV = Inspiratory capacity
Air that can be breathed in after normal exhalation. Inspiratory capacity
What two volumes are added to achieve Inspiratory capacity? Inspiratory reserve volume and Tidal volume
Why is FRC not measured by Spirometry? FRC includes RV
What is the definition of Functional residual capacity? Volume of gas in lungs after normal expiration
Maximum volume of gas that can be expired after a maximal inspiration. Vital capacity
What volumes make up Vital capacity? TV+IRV+ERV
Total lung capacity (TLC) = IRV + TV + ERV + RV
What is the definition of TLC? Volume of gas present in lungs after a maximal inspiration
What is the approximate volume of TLC? 6.0 Liters
RV approximately is ____________ liters. 1.2
What is the abbreviation of physiologic dead space? V D
What makes up the Physiologic dead space? Anatomic dead space of conducting airways plus alveolar dead space.
What part of the lung is the major contributors to alveolar dead space? Apex
Volume of inspired air that does not take part in gas exchange Physiologic dead space
What is the equation for Physiologic dead space? VT x (PaCO2 - PECO2)/ (PaCO2)
What conditions may increase Physiologic dead space? Lung diseases with V/Q defects
What is the equation for Minute Ventilation? = VT x RR
What is the abbreviation of minute ventilation? VE
What is the definition of Alveolar ventilation? Volume of gas that reaches alveoli each minute
VA = Alveolar ventilation
VA = (equation) (VT - VD) x RR
Elastic recoil definition Tendency for lungs to collapse inward and chest wall to spring outward
Which point the inward pull of lung is balanced by outward pull of chest wall? At FRC
What kind, (-) or (+), intrapleural pressure prevents atelectasis? Negative
At FRC (pressure related): 1. Airway and alveolar pressures equal atmospheric pressure 2. Intrapleural pressure is negative
What is compliance? Change in lung volume for a change in pressure
Compliance is inversely proportional to ___________ ____________. Wall Stiffness
High compliance = Lung is easier to fill
What conditions are associated with high compliance? Emphysema and normal aging
Low compliance = Lung is harder to fill
What conditions are associated with low lung compliance? Pulmonary fibrosis, pneumonia, NRDS, and pulmonary edema
How is surfactant related or associated with compliance? Surfactant increases compliance
What is hysteresis? Lung inflation curve follows a difference curve than the lung deflation curve due to need to overcome surface tension forces in inflation.
What are the changes seen in lung compliance and chest wall compliance in the elderly? Increase lung compliance and a decrease chest wall compliance
What are the two forms of hemoglobin? 1. Deoxygenated 2. Oxygenated
How many polypeptides subunits compose the hemoglobin? 4 subunits
What are the polypeptides subunits that make up hemoglobin? 2 alpha and 2 beta
Which form of hemoglobin has low affinity for Oxygen? Deoxygenated
_________________ has a very high affinity for oxygen. Oxygenated
Which type of Hb has higher oxygen affinity, fetal or adult? Fetal hemoglobin
What are the subunits of fetal hemoglobin? 2 alpha and 2 gamma
Hemoglobin acts as a ________ for H+ ions. Buffer
How is myoglobin composed? A single polypeptide chain associated with one heme moiety.
Does myoglobin and hemoglobin have higher affinity to oxygen? Myoglobin
What are the effects of adverse hemoglobin modifications? Tissue hypoxia from decreased oxygen saturation and decreased oxygen content.
What 2 common conditions that lead to hemoglobin modifications? Methemoglobin and Carboxyhemoglobin
What is methemoglobin? The replacement of Fe2+ in hemoglobin by Fe3+.
What is the common or regulate of iron in Hb? Reduced state (Fe2+)
What is the common presentation of methemoglobinemia? Present with cyanosis and chocolate-colored blood.
What is the common treatment for Methemoglobinemia? Methylene blue and vitamin C
How do nitrates cause poisoning? By oxidizing Fe2+ to Fe3+
What is Carboxyhemoglobin? Form of Hb bound to CO in place of oxygen.
What kind of shift in the oxygen-Hb curve is seen with Carboxyhemoglobin? Left shift
Relation between CO and Hb: CO binds to Hb and with 200x greater affinity to than oxygen
Which, carbon monoxide or Hb, has greater oxygen affinity? Carbon monoxide
What is the clinical presentation of CO poisoning? Headaches, dizziness, and cherry red skin
Cherry red skin is a key features of: CO poisoning
What are common causes of CO poisoning? Fires, car exhaust, or gas heaters
What is the treatment for CO poisoning? 100% oxygen and hyperbaric O2
Cyanide poisoning is due to: Inhibition of aerobic metabolism via complex IV inhibitor leading to hypoxia unresponsive to supplemental oxygen and increase anaerobic metabolism.
What are the classic findings of CN poisoning? Almond breath odor, pink skin, and cyanosis
What is the treatment of CN poisoning? Induced methemoglobinemia
What is the first step in Induced methemoglobinemia in treating CN poisoning? Nitrates (oxidize hemoglobin to methemoglobin, which traps cyanide)
How do nitrates work in treating cyanide poisoning? Hb oxides into methemoglobinemia, which can trap cyanide, converting it into cyanmethemoglobin
What is the second step of CN poisoning treatment by induced methemoglobinemia? Thiosulfates, in order to concert cyanide to thiocyanate, and be renally excreted
What is the shape of the oxygen-hemoglobin curve? Sigmoidal
Why does myoglobin does not show positieve cooperativity? Because it is monomeric
What does a shift to the right represent in the Oxygen - hemoglobin curve? Decrease in HB affinity for O2 ( facilitates unloading O2 to tissue)
Shifting to the curve (O2-Hb) to the left ---> Decreased O2 unloading --> renal hypoxia --> increased EPO synthesis
What is synthesized in increased amounts when there is a shift to he left in the Oxygen-Hb curve? EPO
What direct stimulation causes increased synthesis of EPO during a Left-shift of Oxygen - Hemoglobin curve? Renal hypoxia
Fetal Hb has a _____________ shift in the oxygen-hemoglobin curve. Left
Common actions/levels that cause a right shift of the Oxygen hemoglobin curve: Increase in: H+ content (decrease pH) PCO2 Exercise 2, 3-BPG High altitude Temperature
What is the abbreviation of partial pressure of O2 in arterial blood? PaO2
With a decrease in Hb, what are the changes in O2 content, O2 saturation, and PaO2? - DECREASE in Oxygen content in arterial blood - No changes in O2 saturation and PaCO2
Which condition is seen with an obvious increase in Total O2 content? Polycythemia
How is the normal/healthy description of the Pulmonary circulation? Low-resistance and high compliance
What two pressures exert exact opposite effects on Pulmonary and systemic circulation? PO2 and PCO2
What is the result in pulmonary circulation with a decrease in PAO2? Hypoxic vasoconstriction that shifts blood away from poorly ventilated regions of lung to well-ventilated regions of lung.
Normal health is described with a ________________ limited pulmonary circulation and gas exchange. Perfusion
What does a Perfusion limited circulation entails in respect to gas equilibrium? O2, CO2, and N2O equilibrates early along the length of the capillary
What conditions lead to a person to become Diffusion limited in respect to Pulmonary circulation? Emphysema, fibrosis, and exercise
Which type of lung diffusion depicts that gas does not equilibrate by the time blood reaches he end of the capillary? Diffusion limited
What are the most common consequences of Pulmonary hypertension? Cor pulmonale and subsequent right ventricular failure.
Area available for optimal gas exchange is decreased in _________________. Emphysema
What condition/pathology decreases the alveolar wall thickness making less optimal for gas exchange? Pulmonary fibrosis
What is DLCO? The extent to which CO, a surrogate for Oxygen, passes from air sacs of lungs into blood.
Decreased oxygen delivery to tissue Hypoxia
Decrased PaO2 is known as ___________________. Hypoxemia
Ischemia is defined Loss of blood flow
What conditions lead to Hypoxemia with an increased A-a gradient? V/Q mismatch, Diffusion limitation, right-to-left shunt
What are conditions that produce hypoxemia with a NORMAL A-a gradient? High altitude and hypoventilation
A person on heroin will produce---> Hypoxemia due to hypoventilation but with a normal A-a gradient
What is the ideal value to V/Q? 1
What is the approximated V/Q at the apex? 3
What is the approximated V/Q at the base? 0.6
Which part of the lung has "wasted ventilation"? Apex
Which part of lung, apex or base, has "wasted perfusion"? Base
Both, perfusion and ventilation are greater at the _____________ of the lung. Base
Why do exercise causes V/Q to approach to 1? Vasodilation of apical capillaries
An organism that likes or thrives on high oxygen will be found most likely in which part of the lung? Apex
A shunt or obstruction cause the V/Q to approach to _______. Zero
A blood flow obstruction will produce that the V/Q approaches to ____________________. Infinity
A V/Q value that approaches infinity indicates? Blood flow obstruction
What is a common example of blood flow obstruction causing an infinity value of V/Q? Physiologic dead space
Which kind of pathological cause of V/Q changes is treated or improved with 100% oxygen? Blood flow obstruction
A pulmonary embolism will cause the V/Q to reach ____________. Infinity
P A > Pa > Pv is seen in which zone of the lung? Zone 1
Pa> Pv > P A is representative of which lung zone? Zone 3
Decreased in V/Q is seen in Zone ____ of the lung. 3
What form is most carbon dioxide (CO2) transported in the body? HCO3-
What is the abbreviation of carbaminohemoglobin? HbCO2
How much CO2 is transported as HbCO2? 21-25%
Approximate percentage of CO2 transported as HCO3-? 70%
What is the least form of CO2 transportation? Dissolved CO2 (5-9%)
At which part does CO2 bind to Hb? At the N-terminus
What type of Hb is favored by CO2? Deoxygenated
The oxygenation of Hb in the lungs causes? Dissociation of H+ from Hb
What is the Haldane effect? The oxygenation of Hb in lungs promotes the dissociation of H+ from Hb, which shifts equilibrium toward CO2 production; this CO2 is released then from RBCs
The Haldane effect occurs in the ______________. Lungs
Where does the Bohr effect take place? Peripheral tissues
Incrase H+ form tissue metabolism shift curve (oxygenation) to right, unloading Oxygen. Bohr effect
Which part of blood carries most of CO2? Carried as HCO3- in plasma
What is an important enzyme inside the RBC involved in CO2 transport? Carbonic anhydrase
What enzyme is required in the RBC to convert CO2 + water into HCO3- and be transported properly? Carbonic anhydrase
What happens once CO2 is converted to HCO3- within the RBC? It gets shunted to the plasma to be transported.
What effect does chronic high altitude conditions cause to ventilation? Increase
High altitude increases the synthesis of _________________, which cases increased levels of _______- and ____________. Erythropoietin; Hematocrit and Hemoglobin
What is the renal compensation to high altitude? Increase renal excretion of HCO3- to compensate for respiratory alkalosis
What diuretic is used to further compensate renal excretion of HCO3- in cases of respiratory alkalosis? Acetazolamide
What are important lung complications of high altitude? Chronic hypoxic pulmonary vasoconstriction reesults in pulmonary hypertension and RVH.
Pulmonary hypertension and RVH are possible/severe consequences of chronic hypoxic pulmonary vasoconstriction due to _________________________________. High altitude
What is the response of pH during exercise? Decrease pH due to secondary lactic acidosis
What are common responses to exercise in respect to respiratory conditions? 1. Increased CO2 production 2. Increased O2 consumption 3. Increased ventilation 4. Increased pulmonary blood flow due to incrase cardiac output
What condition or environment causes increased mitochondria production? Response to high altitude
What are the changes to PaO2 and PaCO2 to exercise? No changes
What type of blood, venous or arterial, is seen with changes in levels as response to exercise? Venous
What occurs to the VENOUS CO2 content in blood during exercise? Increases
Is venous O2 (oxygen) content, increased or decreased, as response to exercise? Decreased
Describe the venous content of carbon dioxide and oxygen is a person that just finished a marathon? Increased venous CO2 and decreased venous O2, but normal PaO2 and PaCO2.
At what age is the lung fully and completely formed? 8 years old
What is the first stage of lung development? Embryonic ; Weeks 4-7
Errors in the Embryonic stage of lung development lead to: Tracheoesophageal fistula
What stage of lung development are terminal bronchioles made? Pseudoglandular (weeks 5-17)
What would be the result of a defective Pseudoglandular stage in lung development? Respiration imposible --> death
Respiration is possible at week of pregnancy? 25th week
When do pneumocytes start developing? 20th week
Third stage of lung development Canalicular (weeks 16-25)
Which stage of lung development ends at birth? Saccular
What state of lund development is from week 16 to birth? Saccular
When are terminal sacs developed in relation to the stages of lung development? Saccular stage
What is the last stage of lung development? Alveolar
How does breathing occur in utero? Occurs via aspiration and expulsion of amniotic fluid --> increased vascular resistance through gestation.
At birth, the amniotic fluid in lungs gets replaced by air, which causes ---> Decrease in pulmonary vascular resistance
Approximate number of alveoli at birth 20-70 million
What are two very common Congenital lung malformations? 1. Pulmonary hypoplasia 2. Bronchogenic cysts
What is pulmonary hypoplasia? Poorly developed bronchial tree with abnormal histology
What are some associated conditions of Pulmonary Hypoplasia? Congenital diaphragmatic hernia (usually left-sided), and bilateral renal agenesis (Potter sequence)
What is the most common cause of death in Potter sequence? Pulmonary hypoplasia
Which side is most commonly affected by Congenital diaphragmatic hernia? Left side
What i the cause of bronchogenic cysts? Abnormal budding of the foregut and dilation of terminal or large bronchi.
Discrete, round, sharply defined, fluid-filled densities on CXR in the terminal or large bronchi. Dx? Bronchogenic cysts
Description of Club cells Nonciliated; low columnar/cuboidal with secretory granules
Where are Club cells located? Bronchioles
What are functions or roles of Club cells? 1. Degrade toxins 2. Secret component of surfactant 3. Act as reserve cells
Are club cells ciliated or nonciliated? Nonciliated
What are the 3 types of alveolar cells? Type I pneumocytes, Type II pneumocytes and Alveolar macrophages.
Which alveolar cell covers 97% of alveolar surface? Type I pneumocytes
Type I pneumocytes line the _______________. Alveoli
What cells are squamous, thin for optimal gas diffusion? Type I pneumocytes
What is secreted by Type II pneumocyte? Surfactant from lamellar bodies
What is the purpose or role of surfactant? 1. Decrease alveolar surface tension 2. Prevents alveolar collapse 3. Decrease recoil 4 .Increase compliance
What cells serve as Type I pneumocyte precursors? Type II pneumocytes
Which alveolar cells secrete surfactant? Type II pneumocytes
When do type II pneumocytes proliferate the most? During lung damage
What is the most important lecithin of Surfactant? Dipalmitoylphosphatidylcholine (DPPC)
At what week does surfactant production begin? 20 week of gestation
Surfactant in fetus should be completed by week _______. 35
Cuboidal and clustered + precursors of type I pneumocytes + secretion of surfactant? Type II pneumocytes
Explanation of law of Laplace in respiratory terms Alveoli have increase tendency to collapse on expiration as radius decreases
What happens to alveoli during expiration? Collapse due to the decrease in radius
What is released by Alveolar macrophages? Cytokines and alveolar proteases
What pulmonary macrophages are often seen in pulmonary hemorrhage? Hemosiderin-laden macrophages
Condition in neonate with a surfactant deficiency? Neonatal respiratory distress syndrome
What are the physiological consequences of surfactant deficiency in NRDS? Increase in surface tension leads to alveolar collapse
What are common risk factors associated with NRDS? Prematurity, maternal diabetes, C-section delivery.
Why is NRDS development is associated with maternal diabetes? Increase fetal insulin
What are common complications of NRDS? PDA and necrotizing enterocolitis
What is the treatment of Neonatal respiratory distress syndrome? 1. Maternal steroids before birth 2. Exogenous surfactant for infant
What are possible complication of Therapeutic supplemental O2 in NRDS? 1. Retinopathy of prematurity, 2. Intraventricular hemorrhage 3. Bronchopulmonary dysplasia
Normal Lecithin; Sphingomeylin ratio >2.0
What is the Lecithin: Sphingomyelin ratio needed to diagnose NRSD? < 1.5
What are the 2 zones into which the respiratory tree is divided into? Conducting zone and Respiratory zone
What are the parts of the Conducting zone of the respiratory tree? Nose, pharynx, larynx, trachea, and bronchi
What is the main function of the conducting zone of the respiratory tree? Warms, humidifies, and filters air but does not participate in gas exchange ---> "anatomic dead space"
What is the name given to the area or space of the conducting zone of respiratory tree, that does NOT participate in gas exchange? Anatomic Dead space
How far in the conducting zone does cartilage and goblet cells extendo to? End of bronchi
Epithelium found in the Bronchi? Pseudostratified ciliated columnar epithelium
Where is cartilage found in the conducting zone? Bronchi
Conducting zone path Trachea --> Bronchi --> Bronchioles---> Terminal bronchioles
Where in the conducting zone you can find Simple Ciliated Columnar epithelium? Bronchioles
Epithelium of bronchioles Simple Ciliated Columnar epithelium
Simple cuboidal epithelium is found in the _____________________ of the conducting zone of respiratory tree. Terminal bronchioles
Club cells are found from the __________________ to the __________________ ____________. Bronchioles ----> Respiratory bronchioles
What are the two main divisions of the respiratory zone? Respiratory bronchioles and Alveolar sacs
What is the type of epithelium found in the respiratory bronchioles? Simple cuboidal and squamous epithelium
In which section of the respiratory tree are the capillaries found? Alveolar sacs
What type of bronchioles are found in the respiratory zone of the respiratory tree? Respiratory bronchioles
What part of the respiratory tree participates in gas exchange? Respiratory zone
What does the Respiratory zone consists of? Lung parenchyma; respiratory bronchioles, alveolar ducts, and alveoli.
What are the roles of alveolar macrophages? Clear debris and participate in immune response
How many lobes are in right lung? 3 lobes
How many lobes in the left lung? 2 lobes
Which lung, right or left, has a Lingula? Left lobe
What is the right lung homolog of the Lingula? Right middle lobe
What organ occupies what-would be the third lobe of the left lung? Heart
What mnemonic can be used to describe the relation of the pulmonary artery to the bronchus at each lung hilum? RALS: Right Anterior Left Superior
Anatomical location of the Carina? Posterior to ascending aorta and anteromedial to descending aorta.
Which lung is more common for inhaled foreign bodies? Right lung
Why is the right lung more commonly affected by inhaled foreign bodies? Right mainstem bronchus is wider, more vertical, and shorter than the left.
Where is an aspirated object (eg. peanut) if the person is supine? Right lower lobe
MC lung location of foreign body if inhaled while laying on the right side? Right upper lobe
What position lead to aspirated object to be found in the right lower lobe? Upright and supine
Total number of ribs (one side) 12
Which is the MC position of needle for tension pneumothorax? Between rib 2 and rib 3 space
The horizontal fissure of the lung runs along the ________ rib. 4th
Which structures perforate the diaphragm at T8? IVC and the right phrenic nerve
The IVC and right phrenic nerve perforate the diaphragm at _____. T8
Which are the structure that perforate the diaphragm at T10? Esophagus and Vagus nerve
At which point will the CNX perforate the diaphragm? T10
The CNX (vagus) nerve and the _______________ perforate the diaphragm at ______. T10
Which structures are known to cross or perforate the diaphragm at T12? Aorta, Thoracic duct, and Azygos vein
What nerve (roots) innervate the Phrenic nerve? C3, C4, and C5.
Which vessels are known to perforate the diaphragm at T12? Azygos vein and Aorta
At which point is the thoracic duct will cross or perforate the diaphragm? T12
Pain from the diaphragm is referred to the--------> Ipsilateral shoulder and trapezius ridge
At what point or level does the Common Carotid bifurcates? C4
What structure is known to bifurcate at C4? Common Carotid
The trachea bifurcates at _____. T4
Which structure is known to bifurcate at T4? Trachea
At what level does the abdominal aorta bifurcates? L4
Common bifurcations (structure -------> level): 1. Common Carotid ------> 2. Trachea -----> 3. Abdominal aorta --------> The 4s: 1. C4 2. T4 3. L4
Created by: rakomi
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