FA Respiratory
Terms
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- COPD
- obstruction of air flow -> air trapping in lungs low FEV1/FVC ratio (hallmark)
- chronic bronchitis
- "blue bloater" productive cough for >3 months in 2 or more years hypertrophy of mucus-secreating glands in the bronchioles leading cause is smoking
- emphysema
- "pink puffer" destruction of alveolar walls -> enlargement of airspaces and decreased recoil caused by smoking and alpha1-antitrypsin deficiency -> increased elastase activity
- asthma
- bronchial hyperresopnsiveness -> reversible bronchoconstriction
- bronchiectasis
- chronic necrotizing infection of bronchi -> dilated airways, purulent sputum, recurrent infections, hemoptysis
- Which COPD disease is associated w/ Curschmann's spirals?
- asthma
- Which COPD disease is associated w/ Kartagener's syndrome?
- bronchiectasis
- Which COPD disease is associated w/ alpha1-antitrypsin deficiency?
- emphysema
- Which COPD disease is associated w/ cystic fibrosis?
- bronchiectasis
- restrictive lung disease
- restricted lung expansion -> decreased lung volumes (VC and TLC) FEV1/FVC > 80%
- abestosis
- diffuse pulmonary interstitial fibrosis caused by inhaled asbestos fibers feruginous bodies, ivory-white pleural plaques
- Abestosis increases the risk of what?
- pleural mesothelioma, bronchogenic carcinoma
- Asbestosis and smoking greatly increase the risk of what type of cancer?
- bronchogenic cancer
- Asbestosis is typically seen in what population?
- shipbuilders, plumbers
- neonatal respiratory distress syndrome
- surfactant deficiency -> increased surface tension -> alveolar collapse
- What is the lectin:spingomyelin ratio in the amniotic fluid in neonatal respiratory distress syndrome?
- <1.5
- What is the treatment for neonatal respiratory distress syndrome?
- maternal steroids before birth, artificial surfactant for infant
- Kartagener's syndrome
- dynein arm defect -> immotile cilia
- What disease is Kartagener's syndrome associated with?
- situs inversus
- What types of bronchogenic carcinomas arise centrally?
- squamous cell carcinoma small cell carcinoma
- What types of bronchogenic carcinomas arise peripherally?
- adenocarcinoma bronchioalveolar carcinoma large cell carcinoma
- Small cell carcinoma of the lung may lead to what syndrome?
- Lambert-Eaton syndrome
- What are the complications of lung cancer?
- (SPHERE) Superior vena cava syndrome Pancoast's tumor Horner's syndrome Endocrine (paraneoplastic) Recurrent laryngeal symptoms (hoarseness) Effusions (pleural or pericardial)
- Pancoast's tumor
- carcinoma that occurs in the apex of lungs
- What can Pancoast's tumor affect?
- cervical sympathetic plexus -> Horner's syndrome
- lobar pneumonia
- most frequently caused by pneumococcus intra-alveolar exudate -> consoldiation
- bronchopneumonia
- most frequently S. aureus, H. flu, Klebsiella, S. pyobenes acute inflammatory infiltrates from bronchioles into adjacent alveoli patchy distribution involving >= 1 lobes
- interstitial (atypical) pneumonia
- most frequently caused by viruses (RSV, adenoviruses), Mycoplasma, Legionella, Chlamydia diffuse patchy inflammation localized to interstitial areas at alveolar walls distribution involving >= 1 lobes
- Which type of pneumonia involves intra-alveolar exudate?
- lobar
- Which type of pneumonia is most frequently caused by viruses?
- interstitial
- Which type of pneumonia is most frequently caused by Pneumococcus?
- lobar
- Which type of pneumonia is most frequently caused by S. aureus?
- bronchopneumonia
- Which type of pneumonia is most frequently caused by mycoplasma?
- interstitial
- Which type of pneumonia is most frequently caused by S. pyogenes?
- bronchopneumonia
- Which type of pneumonia is most frequently caused by H. flu?
- bronchopneumonia
- Which type of pneumonia is most frequently caused by Chlamydia?
- interstitial
- Which type of pneumonia is most frequently caused by Legionella?
- interstitial
- Which type of pneumonia is most frequently caused by Klebsiella?
- bronchopneumonia
- What are the physiological responses to high altitude: 1-, 2-, 3-, 4-, 5-, 6-, 7-
- 1- acute increase in ventilation, 2- chronic increase in ventilation, 3- increase in EPO leading to an increase in hematocrit and hemaglobin (chronic hypoxia), 4- increase in 2,3-DPG, 5- Cellular changes (increase in mitochondria), 6- increase in excretion of bicarbonates to compensate for respiratory alkalosis, 7- chronic hypoxic pulmonary vasoconstriction results in RVH
- What is the action of 2,3-DPG?
- binds to hemaglobin so that hemoglobin releases more O2
- What does acetazolamide doe?
- it increases the renal excretion of bicarbonates.
- What are 5 important lung products?
- Surfactant, prostaglandins, histamine, ACE, Kallikrein
- What does surfactant do? What is Surfactant? What makes Surfactant?
- It decreases alveolar surface tension which increases complaince, it is made of dipalmitoyl phosphatidylcholine (lecithin), it is produced by type II pneumocytes
- What pathologic process has a deficiency of Surfactant?
- Neonatal RDS
- What are the funcitons of ACE
- converst angiotensin I to Angiotensin II, inactivates bradyykinin (ACE inhibitors yield increase bradykinin and cause cough, angioedema)
- What is the colapsing pressure
- 2(tension)/Radius
- What does Kallikrein do?
- It activates bradykinin
- What is the Residual volume (RV)?
- air in lung at max expiration
- What is the expiratory reserve volume (ERV)?
- air that can still be breathed out after nl expiration
- What is the tidal volume (TV)?
- air that moves into lung with each quiet inspiration (nl = 500ml)
- What is the inspiratory reserve volume (IRV)?
- Air in excess of tidal volume that moves into lung on max inspiration
- What is the vital capacity (VC)?
- TV + IRV + ERV
- What is the functional reserve capacity (FRC)?
- RV + ERV (volume in lungs after normal espiration)
- What is the inspiratory Capacity (IC)?
- IRV+ TV
- What is the total lung capacity (TLC)?
- IRV+TV+ERV+RV
- Decreased affinity of hemoglobin for O2 = shift ___
- Right
- A right shift is caused by an increase or decrase in each of the following factors: P50, metabolic needs, PCO2, temperature, H+, pH, altitude, and 2,3-DPG
- Increase in all but pH
- Fetal Hb curve is shifted ___
- Left (increased affinity for O2)
- T/F: Pulmonary circulation is normally a low-resistance, low-compliance system
- F - Low-resistance, high-compliance
- Cor pulmonale and subsequent RV failure are a consequence of pulmonary ______
- Hypertension
- Hypoxic vasoconstriction that shifts blood away from poorly ventilated regions is caused by ______
- Decrease in PaO2
- In normal health, O2 is perfusion or diffusion limited?
- Perfusion limited - gas equilibrates along the length of the capillary
- Which of the following is diffusion limited: CO2, N2O, or CO?
- CO - gas does not equilibrate by the time the blood reaches the end of the capillary
- When is O2 diffusion limited? What is the equation for Vd?
- Exercise, emphysema, fibrosis (Vt) x (PaCO2 -PeCO2)/PaCO2; Pa = arterial & Pe = expired air
- What is the ideal V/Q ratio?
- V/Q = 1 (permits adequate oxygenation)
- At the base of the lung, there is greater ventilation, perfusion, or both?
- Both are greater
- What is V/Q at the apex of the lung?
- V/Q = 3 (wasted ventilation)
- What is V/Q at the base of the lung?
- V/Q = 0.6 (wasted perfusion)
- V/Q = 0 implies _____
- Airway obstruction (shunt)
- V/Q = infinity implies ______
- Blood flow obstruction (physiological dead space)
- Organisms such as TB that thrive in high O2 flourish in the apex or base of the lung?
- Apex
- During exercise (increased cardiac output), the vessels in the apex of the lung ___-------_______
- Vasodilate such that V/Q approaches 1 (versus normal apex V/Q of 3)
- CO2 is transported from tissue to lungs in these 3 forms: ______
- (1) Bicarbonate (2) Bound to hemoglobin (3) Dissolved CO2
- What percentage of CO2 is transported in the form of bicarbonate?
- 90%
- What is the intracellular enzyme that converts CO2 into H2CO3?
- Carbonic anhydrase
- H2CO3 is broken down into H+ and HCO3. What happens to the H+?
- H+ combines with Hb to form HHb (deoxyhemoglobin)
- H2CO3 is broken down into H+ and HCO3. What happens to the HCO3?
- HCO3 is pumped out of the red blood cell in exchange for Cl-
- What is the Haldane effect?
- Oxygenation of hemoglobin promotes the dissociation of CO2 from hemoglobin
- What does kallikrein do
- Activates bradykinin
- What affect to ACE inhibitors have on bradykinin
- Increase bradykinin, which lead to cough and angioedema
- COPD = also known as OLD: obstructive lung disease: why is it called obstructive?
- obstruction of AIR FLOW → air traping in lungs
- COPD = also known as OLD: obstructive lung disease: what is the major PFT finding?
- FEV1 / FVC ration is ↓ (hallmark finding)
- COPD = also known as OLD: obstructive lung disease: name the 4 types of COPD
- 1) Chronic Bronchitis (Blue Bloater) 2) emphysema (pink puffer) 3) asthma 4) bronchietasis
- COPD = also known as OLD: obstructive lung disease: what is the definition of Chronic Bronchitis
- productive cough for >3 consecutive months in two or more years.
- COPD = also known as OLD: obstructive lung disease: what do you expect on lung histology?
- hypertrophy of mucus-secreting glands in the bronchioles (Reid index of >50%)
- COPD = also known as OLD: obstructive lung disease: leading cause is smoking: what are the physical findings for Chronic Bronchitis? (name 3)
- 1)cyanosis 2) wheezing 3) crackles
- COPD = also known as OLD: obstructive lung disease: what is the pathophysiological mechanism of EMPHYSEMA?
- destruction of fibrous septa/alveolar walls → enlargement of air space and ↓ total surface area for gas exchange
- COPD = also known as OLD: obstructive lung disease: if the cause is smoking, what kind of emphysema would you see on histo slide?
- centri-acinar emphysema
- COPD = also known as OLD: obstructive lung disease: what else can cause emphysema: (also may work synergistically with smoking): What kind of findings do you see in lung histo and name another organ affected?
- alpha 1-antitrypsin deficiency → panacinar emphysema + liver cirrhosis
- COPD = also known as OLD: obstructive lung disease: what causes the emphysema in this disorder?
- ↑ elastase activity to damage lung tissue.
- COPD = also known as OLD: obstructive lung disease: name 4 findings of emphysema (in general)
- 1) dyspnea; 2) ↓ breath sounds 3) tachycardia 4) ↓ I/E ratio
- COPD = also known as OLD: obstructive lung disease: What is mechanism of asthma
- BRONCHIAL hypersensitivity/hyperresponsiveness → REVERSIBLE bronchoconstriction
- COPD = also known as OLD: obstructive lung disease: name 3 common triggers
- 1) viral URI 2) allergens 3) stress!!
- COPD = also known as OLD: obstructive lung disease: name 7 findings
- 1) cough 2) wheezing 3) dyspnea 4) hypoxemia 5)↓ I/E ratio 6) tachypnea 7) pulsus paradoxus
- COPD = also known as OLD: obstructive lung disease: BRONCHIECTASIS: what is its mechanism??
- chronic necrotizing infection of BRONCHI → dilated airways, purulent sputum, recurrent infections, hemoptysis (see Robbins for a good discussion of this)
- COPD = also known as OLD: obstructive lung disease: what disorders is bronchietasis commonly associated with?
- 1) bronchial obstruction 2) cystic fibrosis 3) poor ciliary motility
- Restrictive Lung Disease (RLD): What are classic PFT findings for RLD?
- ↓ VC ↓TLC ; FEV1/FVC ration > 80%
- Restrictive Lung Disease (RLD): Name the two MAJOR types of RLD
- 1) poor breathing mechanics (EXTRA-pulmonary) 2) Interstitial lung diseases
- Restrictive Lung Disease (RLD): cover up various parts of the text/table/outline to test yourself on the following: 1) 2 types of poor breathing mechanics 2) 8 types of interstitial disease that give you a restrictive picture.
- 0
- Lung Physical Findings: cover up parts of the very good table to test yourself on various findings.
- 0
- Lung Physical Findings: Obstructive vs. Restrictive findings
- 0
- Lung Physical Findings: Name 3 lung volumes that are increased in COPD
- ↑TLC, ↑FRC, ↑RV
- Lung Physical Findings: What 2 values are BOTH reduced in COPD and RLD?
- 1) FEV1 and 2) FVC (think FEV1/FVC ratio) NOTE! in COPD, FEV1 is more dramatically reduced and thus the FEV1/FVC ratio is ↓
- Asbestosis = long latency = think shipbuilders and plumbers: what is the main pathology resulting from asbestosis?
- DIFFUSE, interstitial fibrosis caused by inhaled asbestos Fibers.
- Asbestosis = long latency = think shipbuilders and plumbers: What cancers are increased in pts with asbestosis?
- 1) pleural mesothelioma 2) bronchogenic carcinoma (BC)
- Asbestosis = long latency = think shipbuilders and plumbers: Major finding in lung?
- Ferruginous bodies: asbestos fibers coated with hemosiderin also 2) ivory white pleural plaques
- Neonatal respiratory distress syndrome: What is the main cause
- surfactant deficiency --> to increased surface tension --> alveolar collapse
- Neonatal respiratory distress syndrome: surfactant is made by which cells? After when?
- type 2 pneumocytes after 35th gestational week
- Neonatal respiratory distress syndrome: what do you measure? Where do you get this fluid?
- lecithin-to-sphingomyelin ratio in the amniotic fluid = measure of lung maturation <1.5 in neonatal distress syndrome
- Neonatal respiratory distress syndrome: what is surfactant made of (chemical name)
- dipalmitoyl phosph-tidyl-choline (DP-PTC)
- Neonatal respiratory distress syndrome: treatment for poor maturation of lungs
- 1) before birth = maternal steroids 2) after= artificial surfactant
- Karta-gener's syndrome: what is this?
- immotile cilia due to dynein arm defect
- Karta-gener's syndrome: results in what in female and male? (4 things)
- 1) sterility (in male sperm also immotile) 2)bronchietasis 3)recurrent sinusitis (bacteria & particles not pushed out) 4) associated with situs inversus (e.g. dextro-cardia)
- Lung Cancer: name the 3 main classes of cancers that affect parts of the lung
- 1) bronchogenic carcinoma (with different subtypes) 2) carcinoid tumor 3) metastasis
- Lung Cancer: list the 5 types of major bronchogenic carcinomas
- CENTRAL 1) squamous cell ca 2)small cell ca PERIPHERAL 3) adenocarcinoma 4) bronchoalveolar ca 5) large cell ca
- Lung Cancer: mnemonic: what is meant by SPHERE of symptoms?
- S= superior vena cava syndrome; P= pancoast tumor; H= Horner's syndrome; E= Endocrine (paraneoplastic); Recurrent laryngeal / hoarseness; E = Effusions (pleural OR pericardial)
- Lung Cancer: What can a CARCINOID tumor cause?
- Carcinoid Syndrome = flushing, diarrhea, wheezing, and salivation
- Lung Cancer: Metastases to lung is very common, LUNG cancer also prone to metastasize to what other parts?
- 1) brain (epilepsy) 2) bone (fracture) 3)liver (jaundice + hepatomegaly)
- Pancoast tumor: What is it?
- it's a carcinoma of the apex of lung
- Pancoast tumor: what may it affect?
- may affect CSP= cervical sympathetic plexus causing Horner's syndrome
- Pancoast tumor: what is Horner's syndrome?
- P.A.M. is Horny = Ptosis, Anhydrosis, Miosis
- Pneumonia: 1st AID breaks it down into TYPE/ ORGANISM/ CHARACTERISTICS = cover parts of this table and fill in the blanks
- 0
- Pneumonia: Lobar Pneumonia; Organism(s) and characteristics
- Pneumococcus; intraalveolar exudate -> consolidation, may involve entire lung
- Pneumonia: Bronchopneumonia: Organism and characteristics
- S aureus, H flu, Klebsiella, S pyogenes; Acute inflammatory infiltrates from bronchioles into adjacent alveoli; patchy distribution involving >= 1 lobes
- Pneumonia: Interstitial pneumonia; Organism(s) and characteristics
- Viruses, mycoplasma, legionella; diffuse patchy inflammation localized to interstitial areas at alvolar walls; distribution involving >= 1 lobes
- Arachidonic acid products: What enzyme breaks down membrane lipid into arachidonic acid?
- Phospholipase A2
- Arachidonic acid products: What two enzymes are responsible for the production of Hydroperoxides (HPETEs) and Endoperoxidases, respectively from arachidonate?
- Lipoxygenase= HPETE, Cyclooxygenases=endoperoxidases
- Arachidonic acid products: What major class of products do HPETEs give rise to?
- Leukotrienes
- Arachidonic acid products: What are the 3 major products of Endoperoxidases?
- Prostacyclin (PGI), Prostaglandins (PGE, PGF), Thromboxane (TXA)
- Arachidonic acid products: In general what effect do leukotrienes have on bronchial tone?
- Leukotrienes in general increase bronchial tone
- Arachidonic acid products: In the arachodonic acid pathway, what two enzymes do corticosteroids block?
- Phospholipase A2, COX-2
- Arachidonic acid products: NSAIDs, Acetaminophen and COX-2 inhibitors block which arachadonic acid pathway enzymes
- NSAIDs-non-selectively block COX-1 and COX-2, acetaminophen doesn't block COX-1 or COX-2, but instead it may block COX-3 in found in the brain, COX-2 inhibitors block COX-2
- Arachidonic acid products: What are the 4 major effects of Prostacyclin
- decrease platelet aggregation, decrease vascular tone, decrease bronchial tone, decrease uterine tone
- Arachidonic acid products: What are the 3 major effects of Prostaglandins
- increased uterine tone, decrease vascular tone, decrease bronchial tone
- Arachidonic acid products: What are the 3 major effects of Thromboxane
- increase platelet aggregation, increase vascular tone, increase bronchial tone
- Arachidonic acid products: Zileuton is a ________ pathway inhibitor?
- Lipoxygenase
- Arachidonic acid products: Zariflukast is associated with what enzymes?
- Lekukotrienes
- Asthma drugs: Bronchodilation is mediated by what molecule
- cAMP
- Asthma drugs: Bronchoconstriction is mediated by _________ and ___________
- Ach and adenosine
- Asthma drugs: How many asthma drug categories are there?
- 7- (1) nonspecific B-agonists, (2) B2 agonists, (3) Methylxanthines, (4) muscarinic antagonist, (5) cromolyn, (6) corticosteroids, (7) Antileukotrienes
- Asthma drugs: What is the only nonspecific B-agonist drug and what are its effects?
- Isoprotenerol-relaxes bronchial smooth muscle (B2) and tachycardia (B1) (adverse effect).
- Asthma drugs: What are the two B2 selective agonist asthma drugs?
- Albuterol- relaxes bronchial smooth muscle (B2), Salmetrol
- Asthma drugs: What are the indications for Albuterol and Salmetrol, respectively?
- Albuterol- use during acute exarcebation, Salmetrol- long-acting agent for prophylaxis
- Asthma drugs: what are the notable adverse effects of B2 agonist?
- arythmias and tremor
- Asthma drugs: B2-agonists activate this enzyme in bronchial smooth muscle that leads to an increase in ________ = bronchodilation
- B2 agonists activate adenylate cyclase and increase conversion of ATP to cAMP
- Asthma drugs: What are the likely mechanism of action theophylline?
- bronchodialation by inhibition phosphodiesterase (PDE), decreasing cAMP hydrolysis and antagnonizing adenosine action
- Asthma drugs: Why is usage of theophylline limited?
- limited b/c narrow therapeutic index (cardiotoxicity, neurotxicity)
- Asthma drugs: What kind of drug is Ipratropium?
- muscarinic antagonist
- Asthma drugs: How does mechanism of action of Ipratropium?
- competitive block of muscarinic receptors= prevention of bronchoconstriction
- Asthma drugs: cromolyn works by inhibiting the release of _______ from ______ cell?
- prevents release of medicators from mast cells
- Asthma drugs: Cromolyn is mainly used for the ______ of athsma and it is not indicated for _______ treatment of athsma?
- Used only for prophylaxis, not effective during acute episode. Also, toxicity rare
- Asthma drugs: __________and ________ are two major corticosteroids used for treatment of what kind of asthma?
- Beclomethasone and prednisone are 1st line therapy for chronic asthma
- Asthma drugs: What is the mechanism of action of corticosteroids?
- inhibits the synthesis of virtually of cytokines-->inactivates NF-KB, the transcription factor that induces the production of TNF-a, amonth other inflammatory agents.
- Asthma drugs: Zileuton blocks the conversion of _______ to ________.
- zileuton is a 5-lipoxygenase pathway inhibitior. Blocks the conversion of arachidonic acti to leukotrienes
- Asthma drugs: Zafirlukast works by_______ ________ ________
- bloking leukotriene receptors
- Asthma drugs: What the most basic asthma treatment strategy?
- avoidance of exposure to antingen (dust, pollen, etc)
- Asthma drugs: After exposure to antigen crosslinks IgE on mast cells. This is prevented by the following drugs: _________ and ________
- cromolyn and steroids
- Asthma drugs: Following allergen exposure mediators are released (ex. _______ and _________). This triggers an ______ asthmatic response characterized by ________ and may be treated with the following 3 asthmatic drug categories to treat the symptoms.
- examples of mediators are leukotrienes and histamine. Following allergen exposure an early asthmatic response characterized by bronchoconstriction that can be treated with B-agonsists, methylxanthines, and muscarinic antagonists.
- Asthma drugs: Also, mediators elicit a ________ response is which leads to bronchial __________ and is treated with __________.
- mediators elicit a late response and this leads to bronchial hyperactivity. This is best treated with steroids.