189 First Aid CH 17 Respiratory Flashcards PDF

www.natures.
ir
More Free USMLE , MCCEE , MCQE and AMQ Flashcards
Conducting zone
Consists of
Respiratory zone
Consists of
nose, pharynx, trachea, bronchi,

bronchioles, and terminal
bronchioles.
respiratory bronchioles, alveolar

ducts, and alveoli.
Pneumocytes
Pseudocolumnar ciliated cells
extend to the
respiratory bronchioles;
Pneumocytes
extend to the respiratory
bronchioles
Pseudocolumnar ciliated cells
Pneumocytes
terminal bronchioles.
goblet cells extend to the
Pneumocytes
extend to the terminal
bronchioles.
goblet cells
Pneumocytes
%'s
Type I cells (97% of alveolar

surfaces)
Type II cells (3%)
role of
line the alveoli.
Type I cells
role of
Type II cells
role of
clara cells
ratio of in amniotic
uid is indicative of fetal
lung maturity.
bronchopulmonary segment
structure
what is described by RALS
-secrete pulmonary surfactant.

-serve as precursors to type I
cells and other type II cells. Type
II cells
secrete a component of surfactant
- degrade toxins - act as reserve
cells
A lecithin-to-sphingomyelin
ratio of > 2.0
3(segmental) bronchus
- 2 arteries (bronchial
and pulmonary) in the center veins and lymphatics drain along
the borders.
the heart. The relation of the
pulmonary artery to the
bronchus at each lung hilus
is described by RALS
Right Anterior; Left
Superior.
-T8: IVC.
Structures perforating diaphragm
-T10: esophagus, vagus (2

trunks).
what and levels

-At T12: aorta (red), thoracic duct
(white), azygous vein (blue).
Pain from the diaphragm can be
referred to
the shoulder.
Inspirationexternal intercostals,
scalene muscles, sternomastoids.
Muscles of respiration
in exercise
5 Important lung products
Expirationrectus abdominis,
internal and external obliques,
transversus abdominis,internal
intercostals.
-Surfactant
-ACE
-Prostaglandins
-histamine
-Kallikrein
dipalmitoyl phosphatidylcholine
Surfactant
or
aka
lecithin
2T/R
Collapsing pressure =
T=tension
R= radius
what activates bradykinin
Kallikrein
role of Kallikrein
activates bradykinin
role of ACE in lung
angiotensin I angiotensin II;

inactivates bradykinin
lung effects of ACE inhibitors and

other effect
ACE inhibitors bradykinin and

cause cough, angioedema)
alveolar surface tension

role of surfactant/mech
compliance
TLC =
IRV + TV + ERV + RV
VC =
TV + IRV + ERV
TV + IRV + ERV
VC
IRV + TV + ERV + RV
TLC
what causes a shift of the curve

to the right.
An in all factors (except pH)
what causes a shift of the curve to

the left.
A in all factors (except pH)
Pulmonary circulation
Normally a low-resistance, highcompliance system.
normal resistnace and compliance
A in PaO2 causes
Perfusion limited
what molecules / when / describe
/ how to change
a hypoxic vasoconstriction that

shifts blood away from
poorly ventilated regions of lung
to well-ventilated regions of lung.
O2 (normal health),
-CO2,
-N2O.
Gas equilibrates early along the
length of the capillary. Diffusion
can be only if blood ow .
O2 (exercise, emphysema,
brosis),
-CO.
-Gas does not equilibrate by the
Diffusion limited
time blood reaches the end of the
what molecules / when / describe
capillary.
Normal pulmonary artery pressure
Normal pulmonary artery pressure
= 1014 mm Hg; or >35 mm Hg
=
during exercise.
and when is it changes
-pulmonary HTN 25 mm Hg
Primaryunknown etiology, poor
prognosis.
Pulmonary hypertension
primary vs secondary
O2 content =
Secondaryusually caused by
COPD, also can be caused by L
R shunt.
(O2 binding capacity %
saturation) + dissolved O2.
O2 content of arterial blood as
[Hgb] falls,
O2 changes as Hb falls
but O2 saturation and arterial
PO2 do not.
Arterial PO2 with
chronic lung disease; physiologic

shunt O2 extraction ratio
not decrease in Hb
-Normally 1 g Hgb can bind

-normal Hgb amount in blood
-1 g Hgb can bind 1.34 mL O2;

-Hgb amount in blood is 15 g/dL.
-Normal O2 binding capacity
-O2 binding capacity 20.1 mL

O2 / dL.
A-a gradient may occur in
-hypoxemia; causes include

shunting, high V/Q mismatch,
brosis (diffusion block)
CO2 transport forms
1. Bicarbonate (90%)
2. Bound to hemoglobin as
carbaminohemoglobin (5%)
3. Dissolved CO2 (5%)
Haldane effect
In lungs, oxygenation of
hemoglobin promotes dissociation
of CO2 from hemoglobin
Bohr effect
In peripheral tissue, H+ shifts

curve to right, unloading O2
7 Response to high altitude
Emphysema
1. Acute in ventilation
2. Chronic in ventilation
3. erythropoietin
4. 2,3-DPG
5. Cellular changes (
mitochondria)
6. renal excretion of bicarbonate
to
compensate for the respiratory
alkalosis
7. Chronic hypoxic pulmonary
vasoconstriction results in RVH
Centriacinar: caused by smoking.
types with causes
Panacinar: 1-antitrypsin
deciency
1-antitrypsin deciency leads to
Panacinar Emphysema and liver

cirrhosis
associated with bullae can

Paraseptal emphysema: what and
rupture pneumothorax;
who
often in young, otherwise healthy
males.
associated with bullae can
rupture pneumothorax;
often in young, otherwise healthy
males.
Paraseptal emphysema
elastase activity.
Emphysema
pathology
Chronic Bronchitis
pathology
Reid index
Bronchiectasis
pathology
Bronchiectasis
complications
Enlargement of air spaces and

recoil resulting from destruction of
alveolar
walls.
Hypertrophy of mucus glands in
the bronchioles Reid index =
gland depth / total thickness of
bronchial wall; in COPD, Reid
index > 50%.
gland depth / total thickness of
bronchial wall; in COPD, Reid
index > 50%.
Chronic necrotizing infection of

bronchi permanently dilated
airways,
purulent sputum, recurrent

infections, hemoptysis.
causes of Bronchiectasis
Associated with bronchial

obstruction, CF, poor ciliary
motility, Kartageners
syndrome.
Asthma triggers
Can be triggered by viral URIs,

allergens, and stress.
Restrictive lung
disease causes
Poor breathing mechanics
(extrapulmonary):
Restrictive lung
disease 8 types
Interstitial lung diseases
(pulmonary):
a. Poor muscular effortpolio,

myasthenia gravis
b. Poor structural apparatus
scoliosis, morbid obesity
1. (ARDS) 2. Neonatal RDS
3. Pneumoconioses
4. Sarcoidosis
5. Idiopathic pulmonary brosis
6. Goodpastures syndrome
7. Wegeners granulomatosis
8. Eosinophilic granuloma
Pneumoconioses
coal miners silicosis, asbestosis
name some
Neonatal respiratory distress
syndrome
Tx
Adult acute respiratory distress
syndrome (ARDS)
pathophys
Adult acute respiratory distress
syndrome (ARDS)
initial damage due to
maternal steroids before birth;

articial surfactant for infant.
Diffuse alveolar damage
alveolar capillary permeability
protein-rich leakage into alveoli.
Results in formation of intraalveolar hyaline membrane.
-neutrophilic substances toxic to
alveolar wall,
-activation of coagulation
cascade,
-oxygen-derived free radicals.
Sleep apnea
types
Sleep apnea
define
Sleep apnea
complications
Asbestosis
mech
Central sleep apneano

respiratory effort.
Obstructive sleep apnea
respiratory effort
against airway obstruction.
Person stops breathing for at
least 10 seconds
repeatedly during sleep.
- systemic/pulmonary
hypertension,
-arrhythmias,
-possibly sudden death.
-chronic fatigue
Diffuse pulmonary interstitial
brosis caused by inhaled
asbestos bers.
risk of:
asbestos
pleural mesothelioma
wrt malignancy
bronchogenic carcinoma.
pneumoconioses
where in lungs
Asbestos and smoking
Asbestosis Mainly affects lower

lobes. Other pneumoconioses
affect upper lobes (e.g., coal
worker's lung).
Asbestosis and smoking greatly
risk of bronchogenic cancer
(smoking not additive with
mesothelioma).
Asbestosis
histo
Bronchial obstruction
-Breath Sounds
-Resonance
-Fremitus
-Tracheal Deviation
Pleural effusion
-Breath Sounds
-Resonance
-Fremitus
-Tracheal Deviation
Pneumonia (lobar)
-Breath Sounds
-Resonance
-Fremitus
-Tracheal Deviation
Pneumothorax
-Breath Sounds
-Resonance
-Fremitus
-Tracheal Deviation
Ferruginous bodies in lung

(asbestos bers coated with
hemosiderin). Ivory-white pleural
plaques
-Absent/ over affected area
-
-
-Toward side of lesion
- over effusion
-Dullness
-
- NC
-May have bronchial
breath sounds over lesion
-Dullness
-
-NC
-
-Hyperresonant
-Absent
-Away from side of lesion
Breath Sounds, Resonance,

Fremitus, Tracheal Deviation
-Absent/ over affected area
-
-
-Toward side of lesion
Bronchial obstruction
- over effusion
-Dullness
-
- NC
Pleural effusion
-May have bronchial

breath sounds over lesion
-Dullness
-
-NC
-
-Hyperresonant
-Absent
-Away from side of lesion
Lung cancer
complications
Pneumonia (lobar)
Pneumothorax
SPHERE of complications:
-Superior vena cava syndrome
-Pancoasts tumor
-Horners syndrome
-Endocrine (paraneoplastic)
-Recurrent laryngeal symptoms
(hoarseness)
-Effusions (pleural or
pericardial)
Lung cancer
-Squamous cell carcinoma
which types are central
-Small-cell
Lung cancer
Adenocarcinoma:
Bronchial
Bronchoalveolar
which types are peripheral

Large cell carcinoma
Lung cancer
describe Squamous cell
carcinoma (gross)
Lung cancer
which have strong smoking
association
Hilar mass arising from bronchus;

Cavitation;
-Squamous cell carcinoma

-Small-cell
Lung cancer
Undifferentiated very
aggressive
Small-cell (oat-cell) carcinoma
Lung cancer
ectopic production of ACTH or
ADH
Lung cancer
Lambert-Eaton syndrome.
Lung cancer histology


Squamous cell carcinoma
Neoplasm of neuroendocrine
Kulchitsky cells small dark
blue cells.
Keratin pearls and intercellular

bridges.

Neoplasm of neuroendocrine
Kulchitsky cells small dark
blue cells

Keratin pearls and intercellular
bridges
Clara cells type II pneumocytes
multiple densities on x-ray of
chest.
both types of Adenocarcinoma:

Bronchial
and
Bronchoalveolar
Pleomorphic giant cells with

leukocyte fragments in
cytoplasm.
Both Types: Clara cells type II

pneumocytes multiple densities
on x-ray of chest.
Adenocarcinoma

Lung cancer characteristics

Adenocarcinoma: Bronchial
Pleomorphic giant cells with

leukocyte fragments in
cytoplasm.
Develops in site of prior

pulmonary inammation or injury

most common lung CA in nonsmokers

Develops in site of prior
pulmonary inammation or injury
Not linked to smoking.
Adenocarcinoma:
Bronchoalveolar

parathyroid-like activity PTHrP

Hilar mass arising from bronchus;
Cavitation

Highly anaplastic undifferentiated
tumor; poor prognosis.

Carcinoid tumor
Highly anaplastic undifferentiated

tumor; poor prognosis.
Secretes serotonin, can cause
carcinoid
syndrome (ushing, diarrhea,
wheezing,
salivation).

ushing, diarrhea, wheezing,
salivation
Carcinoid tumor

most common. Brain (epilepsy),
bone (pathologic fracture), and
liver (jaundice,
hepatomegaly).
Metastases
Lung cancer common

presentation features
cough, hemoptysis, bronchial

obstruction, wheezing, pneumonic
coin lesion on x-ray lm.
cough, hemoptysis, bronchial

obstruction, wheezing, pneumonic
coin lesion on x-ray lm.
Lung cancer
Pancoasts tumor
where and findings
Carcinoma that occurs in apex of
lung and may affect cervical
sympathetic plexus, causing
Horners syndrome.
Kulchitsky cells
Lambert-Eaton syndrome
findings
causes
Carcinoma that occurs in apex of

lung and may affect cervical
sympathetic plexus, causing
Horners syndrome.
Pancoasts tumor
Enterochromaffin (EC) cells

(Kulchitsky cells) are a type of
enteroendocrine cell[1] occurring
in the epithelia lining the lumen of
the gastrointestinal tract. also
implicated in the origin of small
cell lung cancer.
progressive weakness that does
not usually involve the respiratory
muscles and the muscles of face.
In patients with affected ocular
and respiratory muscles, the
involvement is not as severe as
myasthenia gravis. The proximal
parts of the legs and arms are
predominantly affected.
small-cell lung cancer, lymphoma,
non-Hodgkin's lymphoma
progressive weakness that does

not usually involve the respiratory
muscles and the muscles of face.
In patients with affected ocular
and respiratory muscles, the
involvement is not as severe as
myasthenia gravis. The proximal
parts of the legs and arms are
predominantly affected.
Small-cell carcinoma
aka
oat-cell carcinoma
oat-cell carcinoma
aka
Small-cell carcinoma
Lobar - Pneumococcus usually
Pneumonia types with different

organism causes
Lobar pneumonia Characteristics
Bronchopneumonia - S. aureus,
H. u, Klebsiella, S. pyogenes
Interstitial (atypical) pneumonia viruses (RSV, adenoviruses),
Mycoplasma,
Legionella, Chlamydia
Intra-alveolar exudate
consolidation; may involve entire
lung
Bronchopneumonia
Characteristics
Acute inammatory inltrates

from bronchioles into
adjacent alveoli; patchy
distribution involving 1
lobes
Interstitial (atypical)
pneumonia Characteristics
Diffuse patchy inammation

localized to interstitial areas
at alveolar walls; distribution
involving 1 lobes
Which type of pneumona

Intra-alveolar exudate
consolidation; may involve entire
lung
Acute inammatory inltrates
from bronchioles into
adjacent alveoli; patchy
distribution involving 1
lobes
Diffuse patchy inammation
localized to interstitial areas at
alveolar walls; distribution
involving 1 lobes
Lobar
Bronchopneumonia
pneumonia

Lobar
Pneumococcus most frequently

Bronchopneumonia
S. aureus

Viruses (RSV, adenoviruses)

Mycoplasma, Chlamydia

Legionella
pneumonia
pneumonia
pneumonia
Interstitial pneumonia
aka
atypical pneumonia
atypical pneumonia
aka
Interstitial
pneumonia

Bronchopneumonia
S. aureus

H. u
Bronchopneumonia

Bronchopneumonia
Klebsiella

Bronchopneumonia
S. pyogenes
what are Lung abscess and who

gets them
Pleural effusions what and causes

of
Transudate
Localized collection of pus within

parenchyma, usually resulting
from bronchial
obstruction (e.g., cancer) or
aspiration of gastric contents
(especially in patients
predisposed to loss of
consciousness, e.g., alcoholics or
epileptics).
protein content.
Due to CHF, nephrotic syndrome,
or hepatic cirrhosis.
Pleural effusions what and causes protein content, cloudy. Due to

of
malignancy, pneumonia, collagen
vascular disease,
Exudate
trauma.
Which type of Pleural effusion

protein content
Transudate

Transudate
CHF

Transudate
nephrotic syndrome

Transudate
hepatic cirrhosis

protein content, cloudy
Exudate

Exudate
malignancy

Exudate
pneumonia,

Exudate
collagen vascular disease

protein content
Exudate

Exudate
cloudy

Exudate
trauma
1st generation H1 blockers

names

Clinical uses

Toxicity
Diphenhydramine,
dimenhydrinate,
chlorpheniramine.
Allergy, motion sickness, sleep

aid.
Sedation, antimuscarinic, anti-adrenergic.

mech
2nd generation H1 blockers

mech

names
Reversible inhibitors of H1
histamine receptors.
Reversible inhibitors of H1
histamine receptors.
Loratadine, fexofenadine,
desloratadine.

Allergy.
names

names
Far less sedating than 1st

generation.
Asthma drugs
name the Nonspecic -agonists
Asthma drugs
Isoproterenol
mech and uses
Isoproterenol
Nonspecic -agonists relaxes

bronchial smooth muscle (2).
Asthma drugs
Isoproterenol
Nonspecic -agonists Adverse

effect is tachycardia (1).
toxicity
Asthma drugs
name the 2 agonists
Asthma drugs
Albuterol
mech and uses
Asthma drugs
Salmeterol
Albuterol and Salmeterol
2 agonist relaxes bronchial

smooth muscle (2). Use during
acute exacerbation.
2 agonist long-acting agent for

prophylaxis.
mech and uses

Asthma drugs
Salmeterol
Adverse effects are tremor and

arrhythmia.
toxicity
asthma drug
Adverse effects are tremor and
arrhythmia.
Salmeterol
Asthma drugs
Theophylline
name the Methylxanthines
Asthma drugs
Theophylline
mech and uses
Asthma drugs
Theophylline
tioxicity
Methylxanthine - likely causes

bronchodilation by inhibiting
phosphodiesterase, thereby
cAMP hydrolysis.
Usage is limited because
of narrow therapeutic index
(cardiotoxicity,
neurotoxicity).
Asthma drugs
Usage is limited because
of narrow therapeutic index
(cardio and neuro toxicity).
Methylxanthines: Theophylline
Asthma drugs
Ipratropium
name the muscarinic antagonists
Asthma drugs
Ipratropium
mech and uses
Cromolyn
mech and uses
Asthma drugs
7 different Tx drug classes
competitive block of muscarinic

receptors, preventing
bronchoconstriction.
Prevents release of mediators
from mast cells. Effective
only for the prophylaxis of
asthma. Not effective
during an acute asthmatic attack.
1. Nonspecic -agonists
2.2 agonists
3. Methylxanthines
4. Muscarinic antagonists
5. Cromolyn
6. Corticosteroids
7. Antileukotrienes
Cromolyn
Toxicity is rare.
toxicity
Asthma drugs
Beclomethasone, prednisone
name the corticosteroids
Asthma drugs
mech
1st-line therapy for chronic

asthma.
inhibit the synthesis

of virtually all cytokines. Inactivate
NF-B, the
transcription factor that induces
the production of
TNF-, among other inammatory
agents.
Zileuton
name the Antileukotrienes
Zileuton
Zarlukast, montelukast
A 5-lipoxygenase pathway
inhibitor. Blocks conversion of
arachidonic acid to leukotrienes.
mech and uses

asthma
A 5-lipoxygenase pathway
inhibitor. Blocks conversion of
arachidonic acid to leukotrienes.
Zileuton
Zarlukast, montelukastblock
leukotriene receptors.
mech and uses
Especially good for aspirin

induced asthma.
block leukotriene receptors.
Especially good for aspirin

induced asthma.
Expectorants
names
-Guaifenesin (Robitussin)
-N-acetylcystine
Guaifenesin
aka
Robitussin
Robitussin
aka
Guaifenesin
Guaifenesin
Removes excess sputum but

large doses necessary; does not
suppress cough reex.
mech and uses

Expectorants
Removes excess sputum but

large doses necessary
Guaifenesin
Mucolytic can loosen mucus

plugs in CF patients.
N-acetylcystine
N-acetylcystine
mech and uses
antidote for acetaminophen

overdose
Mucolytic can loosen mucus

plugs in CF patients.
also used as an antidote for
acetaminophen overdose
N-acetylcystine

189 First Aid CH 17 Respiratory Flashcards PDF

Hochgeladen von

Dokumentinformationen

Originaltitel

Copyright

Verfügbare Formate

Dieses Dokument teilen

Dokument teilen oder einbetten

Freigabeoptionen

Stufen Sie dieses Dokument als nützlich ein?

Sind diese Inhalte unangemessen?

Copyright:

Verfügbare Formate

189 First Aid CH 17 Respiratory Flashcards PDF

Hochgeladen von

Copyright:

Verfügbare Formate

www.natures.

nose, pharynx, trachea, bronchi,

respiratory bronchioles, alveolar

Pseudocolumnar ciliated cells

Type I cells (97% of alveolar

what is described by RALS

-secrete pulmonary surfactant.

-T10: esophagus, vagus (2

what and levels

5 Important lung products

what activates bradykinin

role of ACE in lung

angiotensin I angiotensin II;

lung effects of ACE inhibitors and

ACE inhibitors bradykinin and

alveolar surface tension

what causes a shift of the curve

An in all factors (except pH)

what causes a shift of the curve to

A in all factors (except pH)

a hypoxic vasoconstriction that

and when is it changes

Arterial PO2 with

chronic lung disease; physiologic

-Normally 1 g Hgb can bind

-1 g Hgb can bind 1.34 mL O2;

-Normal O2 binding capacity

-O2 binding capacity 20.1 mL

A-a gradient may occur in

-hypoxemia; causes include

CO2 transport forms

In peripheral tissue, H+ shifts

7 Response to high altitude

types with causes

1-antitrypsin deciency leads to

Panacinar Emphysema and liver

associated with bullae can

Enlargement of air spaces and

Chronic necrotizing infection of

purulent sputum, recurrent

Associated with bronchial

Can be triggered by viral URIs,

a. Poor muscular effortpolio,

maternal steroids before birth;

Central sleep apneano

Asbestos and smoking

Asbestosis Mainly affects lower

Ferruginous bodies in lung

Breath Sounds, Resonance,

-May have bronchial

-Squamous cell carcinoma

which types are central

which types are peripheral

Hilar mass arising from bronchus;

-Squamous cell carcinoma

Small-cell (oat-cell) carcinoma

Small-cell (oat-cell) carcinoma

Lung cancer histology

Lung cancer histology

Keratin pearls and intercellular

Lung cancer histology

Small-cell (oat-cell) carcinoma

Lung cancer histology