Term
| Acute respiratory failure involves type 1 hypoxic failure with PaO2<60mm, and type 2 ventilatory faliure with PCO2>50mm. what are normal values? |
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Definition
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Term
| Give examples of the common causes of hypoxic respiratory failure - V/Q mismatch, shunt, hypoventilation, diffusion impairment, low FiO2, reduced mixed venous blood. |
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Definition
| V/Q is ventilation with low perfusion that responds to O2, shunt (ASD,VSD) is no ventilation like pneumonia that doesnt respond to O2, diffusion impairment due to thick alveolar membrane or capillary dilation due to uncleared mediators in ESLD, Low FiO2 in mountains, Low mixed in CHF and abnormal lungs. |
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Term
| The Alveolar-Arterial PO2 gradient can be calculated by finding PAO2=150-PACO2/.8 or 150-PaCO2*1.25. what is normal gradient? |
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Definition
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Term
| Walk through A-a gradient diagnosis in respiratory failure. |
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Definition
| If gradient is OK then hypoventilation causes low PO2, If INCREASED give O2, if improves then V/Q, if not then shunt |
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Term
| Name this respiratory pathology - neutrophilic toxins in blood cause damage to alveolar membrane causing fluid leak into alveoli. Hyaline fibrosis in alveolus is result of chronic insult. Caused by trauma, sepsis, shock, aspiration, uremia, acute pancreatitis. |
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Definition
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Term
| What are some benefits of PEEP and a disadvantage? |
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Definition
| Recuits collapsed alveoli, improves oxygenation by reduing shunt but it decreases cardiac output. |
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Term
| In respiratory acidosis the most common problem is decreased ____________ ____________. |
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Definition
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Term
| Damage to the medulla and pons decreases respiratory drive but what diaphragm problems can also decrease it? |
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Definition
| C3-C5 spinal cord problems, polymyositis, muscular dystrophy, polio, ALS |
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Term
| Name this pulmonary function test: maximal flow rates and vital capacity measured during a forced exhalation. |
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Definition
| Spirometry, tests FEV1/FVC and such |
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Term
| What are the hallmark spirometry changes in restrictive vs obstructive lung disease? |
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Definition
| Restrictive is Fev1/FVC>80% but decreased TLC, obstructive is <80% because FEV1 is more sharply reduced while up TLC |
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Term
| What is the change in lung volume seen in restrictive disease? |
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Definition
| Down TLC, VC, and proportional reduction in all volumes |
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Term
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Definition
| Alveolar collapse in lung |
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Term
| T or f, DLCO measure lungs ability to diffuse across membranes as seen in atelectasis, parenychmal destruction, loss of tissue. |
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Definition
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Term
| Diffuse parenchymal disease reduces lung _________. |
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Definition
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Term
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Definition
| It is a restrictive lung disease cause dby inhalation of dust like asbestos, coal, silica |
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Term
| What are some chest wall disease that affect lung function/volume? |
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Definition
| Scoliosis, morbid obesity |
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Term
| Which of the following cell types are involved in restrictive parenchymal disease - fibroblasts, macros, neutros, lymphos, eos, epithelial/endothelial cells. |
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Definition
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Term
| Which of the following drugs can cause diffuse parenchymal lung disease - bleomycin, busulfan, amiodarone, methotrexates? |
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Definition
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Term
| Name this diffuse parenchymal lung disease - lung only granulomatous and vasculitis hypersensitivity reaction to allergens such as grain, animal proteins, fungi, vegetable matter, or chemicals. IgG infiltrate that shifts after 48 hours to 1:2 ratio of CD4/CD8. Acute, asthmatic, chronic types that is tx w/ removing allergen and corticos. |
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Definition
| Hypersensitivity pneumonitis |
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Term
| Name this diffuse parenchymal lung disease - males 20-50, classic pulmonary renal syndrome, IgG deposition on type 4 collagen in basement mem of lung/kid inducing complement, high DLCO, restrictive PFTs, 90% have hemoptysis/anemia/urinary sediment, diagnose with pul hemorrhage/iron-def anemia/glomernephritis and anti-GBM, tx immunosupresion. |
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Definition
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Term
| Name this diffuse parenchymal lung disease - necrotizing granulomas, focal glomerneph, and small vessel vasculitis involving lung and kidneys, systemic or lung only version, c-ANCA against serine protease 3, male 40-50, lab sees anemia/leukocytosis/glomernephritis, cavitation in CR, tx with corticos and cyclophosphamide. |
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Definition
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Term
| Name this diffuse parenchymal lung disease - systemic granulmatous disease, more is Scandinavian>black>peurtos, characterized by non-caseating epithelioid granuloma, high CD4/CD8 ratio in lung but not in blood, restrictive with low DLCO/VA, ages 20-50, X-ray shows hilar adenopathy or parenchymal disease, tx with steroids. |
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Definition
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Term
| Name this diffuse parenchymal lung disease - toxic/inflamm response to small amount of patients undergoing chest irradiation for cancer, diffuse alveolar damage can progress to fibrosis, onset 1-6 months after radiation, x-ray reveals consolidation in treatment area only, tx corticos. |
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Definition
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Term
| Name this diffuse parenchymal lung disease - elderly, progressive insidious onset of cough, dyspnea, fatigue towards death, variable degrees of inflammation, bibasilar reticular pattern on HRCT, VAT biopsy, tx coticos or cytotoxics. |
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Definition
| Idiopathic pulmonary fibrosis from idiopathic pneumonias |
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Term
| T or f, 50-60% of diffuse parenchymal diseases are of unknown origin and classified as one of the idiopathic interstitial pneumonias and lead to idiopathic pulmonary fibrosis. |
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Definition
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Term
| Which anatomical part of the airway presents the most resistance to flow? |
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Definition
| Larynx, trachea, large airways |
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Term
| Why is helium used in severe asthma to deliver O2? |
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Definition
| Increased density increases laminar flow in more of the larger airways |
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Term
| COPD is an obstructive disease with respiratory symptoms of cough, wheezing, sputum, is progressive and associate with abnormal response to noxious gas or pollutants. Airflow limitation is not fully reversible. Describe the FEV1/FVC ratio. |
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Definition
| FEV1 is markedly reduced, while FVC is slightly reduced. So lung volumes are high, but ratio is lower than 80% |
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Term
| The inflammatory response in the patho COPD induces many leukocytes, macros, fibros, and epithalila cells to secrete proteinases that destroy tissue parenchyma in the lungs. Some destructive ones are neutrophil elastase, proteinase, and cathepsin, as well as MMPs. What fights this? |
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Definition
| A1AT fights the elastase, as well as leukproteinase inhibitors, and tissue inhibitors of MMPs. |
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Term
| Describe A1AT deficiency. |
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Definition
| A1AT is an enzyme produced in the liver that blockas elastases. It is a codominant disorder whose only increased risk comes from the ZZ double allele making only 15% of A1AT. Reulsts in emphysema and liver cirrohsis because it cant release the A1AT. |
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Term
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Definition
| Pulmonary HTN induces right heart hypertrophy and failure; happens in late COPD |
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Term
| Name this respiratory disease - onset middle age, chronic productive cough, dyspnea, barrel chest, flat diaphragm, central cyanosis, lower ex edema, reduced breath sounds and wheezing, FEV1/FVC<70, up FRC due up compliance, up RV due to airway closure/trapping, hyperinflation, parenchymal destruction reduces capillary bed and surface area. |
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Definition
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Term
| ID this type of COPD - bronchial hyperresonsiveness causes reversible bronchoconstriction, smooth muscle hypertrophy and Curschmans spirals (shed epithelium from mucus plugs), triggered by viral URI, allergens, stress, GERD, cold, up TLC and FRC from hyperinflation and up RV airtrapping, DLCO normal or increased. |
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Definition
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Term
| What is the difference in inflammation of early and late phase reaction in asthma? |
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Definition
| Early is mast cells and macros releasing histamine, leukotrienes, ROS causing constriction and edema; late is rest of leukocytes releaseing Th2 cytokines (IL2/5, GM-CSF) making it worse and enhancing hyperresponsivesness (methacholine). |
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Term
| T or f, Asthma is greater in men, blacks, and young. |
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Definition
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Term
| How often is well-controlled asthma in regards to outbreaks perweek? |
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Definition
| 2 or less days per week or symptoms |
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Term
| List 2 drugs for each category of asthma meds: beta-ags, methylxanthins, anticholinergics, corticos, antileukotrienes. |
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Definition
| Albuterol (short), Sal/Fometerol (Long); Theophylline, Amophylline; Ipratropium (S), Tiotropium (L); Beclamethsone, Fluticasone, Budesonide; Monte/Zafirlukast LTD4/LTE4 rec antags |
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Term
| Describe COPD management by GOLD stage. |
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Definition
| Start with removing triggers, then add bronchos, then glucose, then O2 therapy |
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Term
| ID this COPD - hypertrophy of mucus glands in bronchioles (REID index>50% measures depth of gland), productive cough for 3 months in 2 years, small airways disease that can lead to chronic inflammation and fibrosis, wheezing, crackles, cyanosis blue bloater |
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Definition
| chronic bronchitis now called small airways disease |
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Term
| ID this COPD - enlarged air spaces and down recoil due to destruction of alveolar walls, centracinar due to smoking, panacinar due to A1AT, up elastase, up lung compliance due to decreased elastic fibers, pink puffer and barrel shaped chest, breath thru pursed lips to increase pressure and prevent airway collapse. |
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Definition
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Term
| ID this COPD - chronic necrotizing infection of bronchi leads to perm dilated airways, purueltn sputum, recurrent infections, hemoptysis |
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Definition
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Term
| What is the diff btw inflammation in COPD vs asthma? |
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Definition
| COPD is neutrophils and macros, asthma is mast cells, eosi and such |
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Term
| Name this respiratory muscle - innervation c4-c8, primary inspiratory muscle, elevates sternuma and increases upper ribcage diameter. |
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Definition
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Term
| Name this respiratory muscle - accessory, expands upper ribcage and sternum. |
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Definition
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Term
| Which of the intercostals muscles are primary inspiratpry muscles? |
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Definition
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Term
| Kyphoscoliosis is more in females, <70 deg insignificant, restrictive, but what is most common etiology? |
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Definition
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Term
| If a patient has paradoxical motion of the diaphragm or asynchrony with chest muscles then it is usually what? |
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Definition
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