CPR - Pulm Exam 3

115 flashcards · Other · by Jared Blackwell

1. What do goblet cells do?

   They secrete mucous and have cilia that move mucous to epiglottis to swallow.

2. What is Emphysema?

   Decreased Lung Recoil. "Big Barrel Chests"

3. Marfan Syndrome

   Fibrillin-1 gene encodes ECM glycoprotein.

4. Pneumothorax Right lung filled with air (black). *complication in Marfan Syndrome.

5. Respiratory Bronchiole THIN membrane.

9. Azygous is on right side and dumps into superior vena cava.

10. Azygous is on right side and dumps into superior vena cava.

11. Sympathetic chain. Azygous goes to superior vena cava. Phrenic nerve. Goes anterior. Large vessels are: Bronchus (cartilaginous structure). Pulmonary artery and vein. *Pulmonary veins are always anterior and inferior.

13. 11) Manubrium. 2) Left brachiocephalic vein. 3) Brachiocephalic artery (only right) 4) Common carotid 5) Subclavian. 33) Right ventricle 25) Descending aorta 6) Esophagus 23) Azygous

14. Right lower lobe pneumonia.

15. What muscles do inspiration?

    External Intercostals Diaphgram Scalenes - raise ribs Sternocleidomastoid - raise sternum

16. What muscles do expiration?

    Internal intercostals Abdominal muscles Rectus muscle Internal/external obliques Transverse abdominis

17. Where is the highest airway resistance?

    Medium bronchi turbulent flow.

18. Where is the lowest airway resistance?

    Terminal bronchioles laminar flow.

19. Where does cartilage extend to?

    End of bronchi. no cartilage or mucus in bronchioles.

20. What is 2-3 BPG

    Found in RBCs and releases O2 from Hb. Decreases O2 affinity to Hb to increase oxygen delivery to tissues. More BPG at high altitudes.

21. Hemoglobin type with low O2 affinity?

    Taut form (T) low O2 affinity tends to release O2 Favored in tissues

22. Which hemoglobin type has high O2 affinity?

    Relaxed form (R) high O2 affinity. Holds onto O2. Favored in lungs.

23. Is the V/Q ratio high in apex or base of lung?

    V/Q high at apex. Higher ventilation than perfusion. High PAO2. Low PACO2.

24. Does apex or base have high PAO2?

    Apex has high PAO2 & low PACO2. At base, perfusion higher with low PAO2 and high PACO2. Low V/Q ratio.

25. Dissociation curve with cyanide and CO poisoining?

    Cyanide has normal curve. CO has left shift. CO will have normal pulse oximetry O2 sat.

26. When is 2,3-DPG increased?

    2,3-DPG increased in hypoxia and acidosis.

27. Aspiration of foreign body standing up location?

    Upright = Right inferior lobe, lower portion.

28. Aspiration of foreign body supine location?

    Right inferior lobe, superior portion.

29. Diaphragm irritation causes pain where?

    Phrenic innervates at C3, 4, 5. "referred" shoulder pain. Gallbladder disease Lower lung mass

30. What does an injured phrenic nerve cause to diaphgragm?

    Diaphragm elevation and dyspnea. "Paradoxical movement" -> injured side elevates with inspiration.

31. Two common causes of increased lung compliance?

    Emphysema & Aging. Decreased compliance = pneumonia, pulmonary fibrosis, pulmonary edema.

32. Is uptake of oxygen in healthy person perfusion or diffusion limited?

    Perfusion limited Becomes diffusion limited in disease i.e. fibrosis, emphysema.

33. What heart sound do you hear with pulmonary hypertension?

    Loud P2 Loud second heart sound at left upper sternal border. *Closure of aortic valve (A2) is before closure of pulmonary valve (P2).

34. Pulmonary fibrosis Diffusion limited. High A-a gradient hypoxemia. Dead space. Hypercapnia (increased CO2).

35. Tuberculosis Affinity for highly oxygenated portions of body. Mostly affects upper lobe because V/Q ratio highest and has highest O2.

36. Hemoglobin binding hydrogen ions does what?

    Converts Hb to taut form, release of O2. Shift curve to right. Occurs with high H+ (tissues). CO2 +H2O <-> H2C03 <-> HCO3- + H+

37. Lobar pneumonia - left lower lobe. Dullness to percussion. Egophony "eeee-->aaa" Fremitus increase "99" Bronchial breath sounds -louder expiration.

38. Physical findings in lobar pneumonia?

    Bronchial Breath Sounds (hear expiration more). Dullness to percussion. Egophony Patient says "eeee" but sounds like "aaaa." Increased fremitus. saying "99".

39. What is pulsus paradoxus?

    Systolic BP DECREASES over 10mmHg on inspiration. Pericardial tamponade status asthmaticus.

40. What is the V/Q in a shunt?

    V/Q = 0 Airway obstruction NOT corrected by 100% O2.

41. What is V/Q in dead space?

    V/Q = infinity. Blood flow obstruction. Fibrosis. Increased CO2.

42. Hyper-inflation. Asthma. Flat diaphragm.

43. Is wheezing normally on inspiration or expiration?

    Normally expiration. Stridor has wheezing on inspiration. Epiglottitis Laryngotracheitis (croup)

44. Is inspiration or expiration affected in variable extrathroracic (upper airway obstruction)?

    Inspiration

45. What occurs to vasculature in lungs when hypoxic?

    Decrease in PAO2 causes hypoxic vasoconstriction.

46. What does the Dorsal Respiratory Group do?

    Rhythmic breathing. The pneumotaxic center in upper pons ends inspiration. Apneustic center in lower pons proloongs inspiration.

47. Does decreased lung volume affect alveolar or arteriolar vessels?

    Decreased lung volumes constricts arteriolar vessels Increases arteriolar resistance.

48. Does increased lung volume affect alveolar or arteriolar vessels?

    Increased lung volume increases alveolar resistance. High lung volume decrease airway resistance. Increase elastic resistance.

49. What does emphysema and pulmonary fibrosis do to the diffusion equation?

    Area decreases in emphysema. Wall thickness increases in pulmonary fibrosis. Vgas = A * Dk * (P1-P2/T)

50. Hypoxemia with normal A-a gradient?

    Hypoventilation Opioids Obesity High altitude.

51. Physical findings in pneumothorax?

    Decreased/absent breath sounds. Decreased fremitus. Hyperresonance on percussion.

52. Physical findings in pleural effusion?

    Decreased/absent breath sounds. Decreased fremitus Dull percussion.

53. Are shunts, dead space, or V/Q mismatch fixed with oxygen?

    Shunts are NOT fixed with oxygen. V/Q mismatch and Diffusion limitation (dead space) are fixed with supp. O2.

54. Which infection is common in upper lobes of lung?

    Tuberculosis. oxygen loving bacteria.

55. During inspiration and expiration how do alveoli & pulmonary vessels react?

    Inspiration= pulm. vessels constrict. Alveoli enlarge. Expiration= pulm. vessels dilate. Alveoli shrink. Vessel dilate to fill blood with oxygen that is coming later.

56. What does a perfusion defect that is not anatomically matched by ventilation defect indicate?

    Blood flow obstruction i.e. pulmonary embolism. Perfusion defect only = PE

57. Ventilation defect that is anatomically matched by perfusion defect indicates what?

    Lung collapse (atelectasis) or airway inflammation/obstruction. Ventilation + Perfusion defect = atelectasis or airway inflammation/obstruction.

58. Ventilation defect without perfusion defect suggestive of what?

    Acute alveolar filling consolidation = Pneumonia, pulmonary edema. Ventilation defect only = pneumonia, pulmonary edema.

59. What do peripheral chemoreceptors respond to?

    ONLY receptors that respond to Hypoxia or acidemia. located in carotid body. aoritic body more impact on CV system.

60. What is the response to high altitude?

    Decreased atmospheric oxygen -> Decrease PaO2 -> Increase ventilation -> Decrease PaCO2 -> Resp. Alkalosis -> Altitude sickness. Increase Hct and Hb Increase 2,3 BPG. Increased renal excretion of HCO3-. Hypoxic pulmonary vasocontriion and pulmonary hypterion with RIGHT ventricular heart failure.

61. What is the gene product in cystic fibrosis?

    CFTR is an ATP binding protein that is an anion channel found in epithelial organs.

62. What does increasing positive pressure ventilation do to blood flow in the different lung zones?

    Blood flow reduced in zone 1.

63. When is PVR the lowest?

    PVR lowest at FRC and increases with lung volume.

64. What does hemoglobin breakdown into?

    Heme --> CO + Fe2+ Heme--> Biliverdin --> Bilirubin.

65. Describe laminar flow

    LOW velocity in small airways.

66. Risk factors of neonatal respiratory distress syndrome?

    Prematurity Maternal diabetes High insulin decreases surfactant production. C-section *causes atelectasis & intrapulmonary shunting.

67. Complications of neonatal respiratory distress syndrome?

    Bronchopulmonary dysplasia PDA (hypoxia keeps shunt open) Retinopathy Oxygen-> ROS-> neovascularization in retina-> blindness.

68. What type of epithelium line the Bronchi?

    Pseudostratified ciliated columnar Resp. Bronchioles have simple ciliated cuboidal.

69. What type of epithelium is present in the true vocal cores (oropharynx)?

    Stratified squamous epithelium.

70. Breathing pattern with increased elastic resistance?

    Rapid, shallow breaths (pulmonary fibrosis, edema, ARDS). Stiff lungs minimize work with high RR and TV low.

71. Breathing pattern with increased airflow resistance?

    Slow, deep breaths (asthma, COPD). Patients with increased airway resistance (e.g. asthma) breathe at higher lung volumes to offset the high airway resistance.

72. What are the four common types of Anterior Mediastinal Masses?

    Four "T's" Thyroid Thymic neoplasm Teratoma "Terrible" lymphoma

73. What do stretch receptors in the lungs do?

    In airway smooth muscle. Slow adaptation vagal inhibition of inspiration. Promote expiration. Distention of lungs causes decreased breathing frequency.

74. What do J-Receptors do?

    In alveolar walls. Unmyelinated w/ rapid adaptation to inflammation & interstitial disease. Cause laryngeal closure and apnea followed by rapid shallow breathing.

75. What do irritant receptors do?

    In extra-pulmonary airway epithelium. Rapid vagal adaption. Does bronchoconstriction, cough, inspiration, rapid/shallow breaths.

76. Increased perfusion of pulmonary capillary beds causes what to resistance?

    Decreases PVR with increased perfusion.

78. Legionella pneumophila Gram negative, NOT seen on gram stain. Causes Bacterial pneumonia. Inhalation of aerosols, NOT airborne.

79. Cytomegalovirus (CMV) Cause of Viral, atypical pneumonia. Transplant patients on immunosuprresive drugs. Intranuclear "bulls eye" inclusions.

80. Coccidiodomycosis Chronic Granulomatous Pneumonia. Inhalation of spores. Usually asymptomatic. Giant cells & macrophages.

81. Histoplasmosis Chronic Granulomatous pneumonia. Ohio River Valley.

82. Blastomycosis Chronic granulomatous pneumonia. Acute disease may appear as bacterial pneumonia.

83. Tuberculosis Chronic granulomatous pneumonia. Miliary TB spreads to liver/spleen:

84. Tuberculosis

85. Pneumocysitis jiroveci Opportuninstic fungi.

86. Aspergillus Opportunistic fungi. Septate hyphae with 45-degree branching. Causes necrotizing pneumonia. Bronchiectasis Invades arteries and veins.

87. Actinomyces and Nocardia Filamentous branching bacteria. Pneumonia progresses to abscesses.

88. Zygomycetes Opportunistic fungi. Nonseptate hyphae branching 90 degrees.

89. Cryptococcus neoformans Opportunistic funigi. May spread to CNS.

90. Candida Opportunistic fungi. May produce bronchitis, bronchopneumonia, acute abscesses.

91. Axial CT Right main stem bronchus with right upper lobe coming right off. Left main stem bronchus is much longer.

92. Where is the abnormality?

    **Spine should get more lucent as you go down. Lateral XR gets more dense.

93. Lobar Pneumonia - left lower lobe. Egophany - "eeee" --> "aaaa" Bronchial breath sounds (louder on expiration) Dull percussion. Increased Fremitus "99"

94. Patchy bronchopneumonia - left lung.

95. Bronchopneumonia - Patchy bilateral airspace opacities. More on right than left.

96. Diffuse Pneumonia - Influenza. Often times may progress to ARDS.

97. Right lung consolidation with small pleural effusion. no diaphragm & CP angle on right side.

98. Abscess formation in right upper lobe. Forming a thick wall cavity on CT. Normal CT

99. Lung abscess from staphylococcal infection. Only know it's staph b/c cultured sputum. Could be due to fungus or tumor as well.

100. Diffuse hazy airspace disease i.e. mycoplasma. Ground-glass opacity,