Term
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Definition
Ends at the terminal bronchioles
Extending to the end of bronchi- cartilage, goblet cells
Extending to the end of the terminal bronchioles- pseudo stratified ciliated columnar cells, sm muscle of airway walls |
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Term
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Definition
Resp bronchioles to alveoli
Cuboidal cells in RB, simple shamus to the alveoli
*no cilia |
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Term
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Definition
| Line the alveoli, squamous for gas diffusion |
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Term
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Definition
Secretes pulmonary surfactant, dec surface tension and prevention of alveolar collapse
Also serve as precursors to type 1 and type 2 cells |
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Term
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Definition
Non ciliated, columnar with secretory granules
Secrete component of surfactant
Degrade toxins |
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Term
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Definition
Complex mix of lecithins
Dipalmatoylphosphatidylcholine is most important
Synthesis begins around 26 wks gestation, mature levels at 35
Lecithin to sphingomyelin ration > 2 indicates maturity |
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Term
| Pulm artery to bronchus relatins |
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Definition
Right anterior
Left posterior |
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Term
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Definition
T8- IVC
T10- esophagus and vagus
T12- aorta, thoracic duct, azygous vein |
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Term
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Definition
C3-C5, Phrenic nerve
Pain gets referred to the shoulder |
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Term
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Definition
Inspiration- external intercostal, scalene muscles, sternocleidomastoid
Expiration- rectus abdominus, internal and external obliques, transversus abdominus and internal obliques |
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Term
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Definition
| Air in lung after maximal expiration |
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Term
| FRC (functional reserve capacity) |
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Definition
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Term
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Definition
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Term
| Determination of physiologic dead space |
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Definition
Vd = Vt x (PaCO2 - PECO2)/(PaCO2)
Apex of lung is the largest contributor of phys dead space |
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Term
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Definition
Tendency for lungs to collapse inward, but chest wall to expand outward
At FRC- there is balance between outward and inward pull. Airway pressure is zero and intrapleural is negative still |
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Term
|
Definition
Inc in emphysema
Dec in pulmonary fibrosis, pneumonia, and pulmonary edema |
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Term
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Definition
2a and 2B units
T form has low affinity for O2
R form has high affinity for O2
Post cooperativity and negative allosterity
Inc Cl, H, CO2 and 2,3 BPG favor taut form (inc unloading) |
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Term
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Definition
Has 2a and 2g chains
Lower affinity for 2,3 BPG so higher affinity for O2 |
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Term
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Definition
Oxidized form of hemoglobin, Fe3+ state, does not bind O2 as readily and has increased affinity for cyanide
To Tx cyanide: nitrites to oxidize hemoglobin to methemoglobin, to preserve cytochrome p450, Use thiosulfate to bind cyanide, which is renal excreted
Tx: methylene blue |
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Term
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Definition
For of Hgb bound to CO in place of O2
Causes dec oxygen binding capacity with a left shift
Dec O2 unloading in tissues |
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Term
| Oxygen Hemoglobin dissociation curve |
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Definition
Myoglobin is monomeric and does not show cooperatively
When curve shifts to the right, dec affinity or O2 (unloading)
Inc in all factors causes a shift to the right (except pH)
Fetal Hgb will be shifted left due to inc affinity for O2
C-BEAT (shift R): CO2, BPG, Exercise, acid/alt, temperature |
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Term
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Definition
Normally low resistance, high compliance
A decrease in PAO2 causes hypoxic vasoconstriction to shunt blood away from poorly ventilated areas |
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Term
| Perfusion limited diseases |
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Definition
O2, CO2, N2O. Gas equilibrates early along the length of the capillary
Diffusion can be inc only if blood flow is inc |
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Term
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Definition
O2 (emphysema), CO
Gas does not equilibrate by the time blood reaches the end of the capillary |
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Term
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Definition
Normal pressure is 10-14
HTN occurs when >25 or 35 during exercise
Results in arteriosclerosis, medial hypertrophy, and intimal fibrosis of the pulmonary arteries |
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Term
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Definition
Due to inactivating mutation in BMPR2 gene (normally inhibits proliferation of sm mm)
Poor prognosis |
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Term
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Definition
COPD, mitral stenosis, recurrent thromboemboli, autoimmune disease, left to right shunt, sleep apnea, or living at high altitude
Death from decompensated for pulmonale |
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Term
| Pulmonar vascular resistance |
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Definition
PVR= (P pulm atery - P L atrium)/ CO
R = 8nl/piR^4 |
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Term
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Definition
= (O2 binding capacity x % saturation) + dissolved O2
Normally 1g Hgb can bind 1.34 ml )2
O2 binding capacity = 20.1 ml O2/dL
O2 content in arterial blood drops as Hgb decreases, but O2 saturation and PaO2 do not change |
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Term
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Definition
PAO2 = PIO2 - (PaCO2/R)
Approx: PAO2 = 150 - (PaCO2/0.8)
A-a gradient shouldn't be more than 10-15 |
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Term
| Normal A-a gradient hypoxemia (dec PaO2) |
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Definition
High altitude
Hypoventilation |
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Term
| Inc A-a gradient hypoxemia (dec PaO2) |
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Definition
V/Q mismatch
Diffusion limitation
Right to left shunt |
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Term
| Hypoxia (dec O2 delivery to tissues) |
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Definition
Dec CO
Hypoxemia
Anemia
CO poisoning |
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Term
| Ischemia (loss of blood flow) |
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Definition
Ipeded arterial flow
Reduced venous drainage |
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Term
|
Definition
Apex of lung: V/Q= 3 (wasted ventilation)
Base of lung: V/Q= 0.6 (wasted perfusion)
With exercise, vasodilation of apical capillaries leads to V/Q approaching 1 |
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Term
|
Definition
CO2 is reansported from tissue to lungs in 3 forms:
-Bicarbonate (90%) plasma
-Carbaminohemoglobin (5%): CO2 bound to hgb at N terminus of globin (NOT heme)
-Dissolved CO2 (5%) |
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Term
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Definition
| Oxygenation promotes dissociation of H from Hgb, shifting equilibrium towards CO2 formation, which releases it |
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Term
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Definition
| Inc H from tissue metabolism shifts curve to the R, unloading O2 |
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Term
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Definition
CO2 enters and is complexed to H20 forming bicarbonate by CA
HCO3/Cl antiporter moves Cl into the cell |
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Term
| Response of high altitude |
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Definition
Inc in ventilation, dec PO2 and PCO2
Inc EPO, inc hematocrit and Hgb
Inc 2,3 BPG to increase peripheral release of O2
Inc mitochondria
Inc renal excretion of bicarbonate to compensate for resp alkalosis |
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Term
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Definition
Inc CO2 production, inc O2 consumption
Inc plum blood flow from increased CO
Dec pH due to lactic acidosis
*No change in PaO2 and PaCO2
Inc in venous CO2 and dec in venous O2 content |
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Term
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Definition
Vichows triad- stasis, hypercoaguability, endothelial damage
Homans sign - calf pain with doseiflexion of the foot |
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Term
|
Definition
Fat emboli are assoc with long bone fractures and liposuction
Hypoxemia, neurologic abnormalities and petechial rash
Amniotic fluid emboli- Lead to DIC, post partum
CT pulm angio test of choice
Lines of zahn present in pre mortem PEs |
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Term
| Obstructive lung diseases |
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Definition
Chronic bronchitis, Emphysema, Asthma, bronchiectasis
Air trapping in the lungs
Airways close prematurely at high lung volumes resulting in Inc in RV and dec in FVC
Dec FEV/FVC ratio, V/Q mismatch |
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Term
|
Definition
Hypertrophy of mucus secreting glands
Reid index (thickness of gland layer) > 50%
Productive cough for > 3 months per year, > 2 years
Disease of small airways |
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Term
|
Definition
Enlargement of air spaces and dec recoil from destruction of alveolar walls
*inc compliance
Centriacinar- assoc smoking
Panacinar- assoc a-1 antitrypsin def
Exhalation through pursed lips to prevent airway collapse |
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Term
|
Definition
Smooth muscle hypertrophy, Curshmann's spirals (shed epithelium forms mucus plugs) Charcot Leyden crystals (breakdown of eos in sputum)
Methacholine challenge |
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Term
|
Definition
Chronic necrotizing infection of bronchi
Permanently dilated airways, purulent sputum, recurrent infections, hemoptysis
Assoc with bronchial obstruction, poor ciliary motility, Kartageners syndrome, CF, allergic aspergillosis |
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Term
|
Definition
Restricted lung expansion causes dec LV, inc ratio >80%
Two types:
Poor breathing mechanics
Interstital lung diseases |
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Term
| Poor breathing mechanics restrictive disease |
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Definition
Normal A-a gradient
Polio, MG, scoliosis, morbid obesity |
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Term
| Interstital lung disease, restrictive lung disease |
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Definition
Inc A-a gradient, due to diffusing capacity lowering
ARDS, neonatal RDS (hyaline membrane disease), Pneymoconiosis, sarcoidosis (inc ACE and Ca), Idopathic plum fibrosis, Goodpasteure's syndrome, Granulomatosis with polyangiitis, Langerhans cell histiocytosis, hypersensitivity pneumonitis,
Drug toxicity: Busulfan, bleomycin, aniodarone, methotrexate |
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Term
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Definition
| Assoc with coal mines, affects upper lobes |
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Term
|
Definition
Assoc with sandblasting, foundries, and mines
Macrophages respond to silica and release fibrogenic factors
Increases risk of bronchogenic carcinoma and TB
Affects upper lobes and has an eggshell calc of hilar nodes |
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Term
|
Definition
Ivory white calcified pleural plaques
Inc risk of bronchogenic carcinoma and mesothelioma
Affects lower lobes
Golden brown fusiform rods resembling dumbbells |
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Term
| Neonatal Respiratory Distress Syndrome |
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Definition
Surfactant deficiency leading to inc surface tension, resulting in alveolar collapse
Lecithin: Sphingomyelin < 1.5
*Therapeutic O2 can lead to retinopathy of the infant and bronchopulmonary dysplasia
Maternal diabetes is a RF, as well as C section
Tx: maternal steroids before birth |
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Term
| Acute Respiratory Distress Syndrome |
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Definition
Diffuse alveolar damage leads to increased capillary permeability, protein rich fluid leakage into the alveoli
Formation of intra-alveolar hyaline membranes
*inital damage from neutrophil release of toxic substances |
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Term
|
Definition
All diseases will have decreased fremitus except:
*consolidation will have increased fremitus |
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Term
|
Definition
| Spontaneous pneumothorax and tension pneumothorax will both have hyper resonance |
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Term
| Lung cancer types assoc with smoking |
|
Definition
All types except:
Broncioalveolar (adenocarcinoma)
bronchial carcinoid |
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Term
|
Definition
Peripheral location
Most common Lung cancer in non smokers and females
K-ras mutation, assoc with clubbing
Hazy infiltrates similar to pneumonia
Apparent thickening of the alveolar walls |
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Term
| Squamous Cell carcinoma of lung |
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Definition
Central hilar mass arising from bronchus
Cavitation, hypercalcemia
*prod PTHrP
Keratin pearls and intercellular bridges |
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Term
| Small cell (oat cell) carcinoma of lung |
|
Definition
Central, very aggressive
ACTH, ADH, or Abs (lambert eaton syndrome)
Amplification of myc oncogenes
*Neuroendocrine neoplasm
Kulchitsky cells |
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Term
| Large cell carcinoma of lung |
|
Definition
Peripheral, highly anaplastic, poor prognosis
Removed surgically
Pleomorphic giant cells |
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Term
| Bronchial carcinoid tumor |
|
Definition
Excellent prognosis
Symptoms due to mass effect
Serotonin secretion, flushing, diarrhea
*nests of neuroendocrine cells, chromogranin pos |
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Term
|
Definition
Malignancy of pleura assoc with asbestosis
Hemorrhage, pleural effusions and pleural thickening
Psammoma bodies on histology |
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Term
|
Definition
| Carcinoma that occurs in apex of lung causing Horner's syndrome |
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Term
| Superior Vena Cava syndrome |
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Definition
Obstruction of the SVC that impairs blood flow from the head, caused by malignancy and thrombosis from catheters
Inc risk of rupture of cranial arteries |
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Term
|
Definition
S pneumo, or Klebsiella
Intraalveolar exudate, consolidation |
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Term
|
Definition
S. pneumo, S aureus, H flu, Klebsiella
Acute inflammatory infiltrates from bronchioles into adjacent alveoli; patchy distribution involving >1 lobe |
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Term
| Interstitial (atypical) pneumonia |
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Definition
Viruses (influenza, RSV, adenovirus), mycoplasma, legionella, chlamydia
Diffuse patchy inflammation localized to interstitial areas at alveolar walls
Generally follows a more indolent course |
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Term
|
Definition
Localized collection of pus within the parenchyma
Bronchial obstruction or aspiration of oropharyngeal contents
Air-fluid levels
S aureus, or anaerobes (bacteroides, fusobacterium, peptostreptococcus) |
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Term
| Hypersensitivity pneumonitis |
|
Definition
Mixed type 3/4 HSN rxn to environmental antigen
Dyspena, cough, chest tightness, headache
Often seen in farmers or people exposed to birds |
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Term
| Transudate pleural effusion |
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Definition
Dec protein content
Due to CHF, nephrotic syndrome, or hepatic cirrhosis |
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Term
|
Definition
Inc protein content
Due to malignancy, pneumonia, collagen vascular disease, trauma
*must be drained to try and prevent infection |
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Term
| Lymphatic pleural effusion |
|
Definition
Known as a cyclothorax
Thoracic duct injury from trauma, malignancy
*Milky appearing fluid; inc triglycerides |
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Term
| H1 blockers 1st generation |
|
Definition
Diphenydramine, chlorpheniramine, dimenhydramine, hydroxyzine
Allergy, motion sickness, sleep aid
Sedation, anti-muscarinic, ant-a adrenergic |
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Term
| H1 blockers 2nd generation |
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Definition
Fexofenadine, Loratidine, desloratidine, cetirizine
Allergy
Far less sedating than 1st gen because of dec entry into the CNS |
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Term
|
Definition
Albuterol- B2, use during acute exacerbation
Salmeterol, formeterol- long acting; can cause tremor or arrhythmia |
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Term
|
Definition
Theophylline
Likely causes bronchodilation by blocking PDE > dec cAMP hydrolysis.
Narrow TI: cardiotox, neurotox
Blocks actions of adenosine
B-blocker is the antidote for OD |
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Term
|
Definition
Ipatropium
Competetive block of muscarinic receptors, preventing bronchoconstriction |
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Term
|
Definition
Beclomethasone, fluticasone
Inhibit synthesis of all cytokines
Inactivates NF-kb which is the TF that makes TNF-a
Ist line for chronic asthma |
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Term
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Definition
Monteleukast, zafirleukast - block LT Rs; good for aspirin induced asthma
Zileuton- 5-liopoxygenase pathway inhibitor; blocks the conversion of arachadonic acid to LTs |
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Term
|
Definition
Monoclonal anti-IgE antibody
Binds mostly to unbound serum IgE
Used in allergic asthma resistant to inhaled steroids and long acting b2 agonists |
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Term
|
Definition
Guaifenesin- thins respiratory secretions
*does NOT suppress cough reflex
N-acetylcysteine- mucolytic, can loosen mucus plugs in CF patients |
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Term
|
Definition
Pulmonary arterial HTN
Competetive antagonist at endothelin 1 receptors
Decreases PulmVR |
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Term
|
Definition
Antitussive (antagonizes NMDA glutamate receptors)
Mild opiod effect when used in excess
Naloxone for OD |
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Term
| Pseudoephedrine, phenylephedrine |
|
Definition
a-agonist, nasal decongestent
Reduce hyperemia, edema and nasal congestion; open obstructed eustachian tubes
HTN, can cause CNS stimulation and anxiety |
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Term
|
Definition
Muscarinic receptor agonist
Asthma challenge testing |
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