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38 Cards in this Set
- Front
- Back
Physical findings in bronchial obstruction
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Breath sounds absent/decreased over affected area
Decreased resonance Decreased fremitus Tracheal deviation toward side of lesion |
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Physical findings in Pleural effusion
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Decreased breath sounds over effusion.
Dullness on resonance Decreased fremitus |
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Physical findings in lobar pneumonia
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May have bronchial breath sounds over lesion.
Dullness on resonance Increased fremitus |
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Physical findings with pneumothorax
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Decreased breath sounds
Hyperresonant on resonance Absent fremitus Tracheal deviation away from side of lesion. |
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Location, Characteristics and Histology of Squamous Cell Lung Cancer
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Central Location
Hilar Mass arising from bronchus. Cavitation. Clearly linked to Smoking, Parathyroid-like activity PTHrP Keratin pearls and intercellular bridges. Squamous Sentral Smoking |
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Location, Characteristics and Histology of Adenocarcinoma.
Bronchial and bronchioalvelar |
Peripheral location.
Developes in site of prior pulm inflammation or injury. most common lung cancer in nonsmokers and females. Bronchioloalveolar - not linked to smoking Both types: Clara cells --> type II pneumocytes; multiple densities on x-ray of chest. |
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Location, Characteristics and Histology of small cell (oat cell) carcinoma.
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Central location.
Undifferentiated, very aggressive. often associated with ectopic production of ACTH or ADH, may lead to Lambert-Eaton syndrome (autoantibodies against calcium channels). responsive to chemotherapy Neoplasm of neuroendocrine Kulchitsky cells --> small dark blue cells. |
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Location, Characteristics and Histology of large cell carcinoma
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Peripheral location.
Highly anaplastic, undifferentiated tumor; poor prognosis; less responsive to chemotherapy. Removed surgically. Plemorphic giant cells with leukocyte fragments in cytoplasm |
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Location, Characteristics and Histology of Carcinoid tumor
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Secretes serotonin, can cause carcinoid syndrome (flushing, diarrhea, wheezing, salivation).
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Location, Characteristics and Histology of Metastasis.
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Very common.
Brain - epilepsy Bone - pathologic fracture Liver - jaundice, hepatomegaly |
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Drugs associated with interstitial fibrosis
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1. Amiodarone
2. Bleomycin and busulfan 3. Cyclophosphamide 4. Methotrexate and methysergide 5. Nitrosourea and nitrofurantoin. |
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Muscles of active inspiration
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external intercostals
scalenes sternomastoids (diaphragm) |
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Muscles of active expiration
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rectus abdominis
internal and external obliques transversus abdominis internal intercostals |
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Vital capacity formula
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= IRV + TV + ERV
(everything but RV) |
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Functional residual capacity formula
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= ERV + RV
volume in the lungs after normal expiration |
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Inspiratory capacity formula
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= TV + IRV
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Physiological dead space
formula and definition |
Vd = Vt x ( (PaCO2 - PeCO2) / (PaCO2)
anatomical dead space of conducting airways plus functional dead space in alveoli. Volume of inspired air that does not take part in gas exchange. |
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Factors that cause a right shift of the hemoglobin-O2 dissociation curve
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Inc CO2
Inc Acid, Altitude Inc 2,3-DPG Inc Exercise (metabolic needs) Inc Temperature Right shift - CADETs face Right |
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Molecules that are perfusion limited
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O2 (healthy), CO2, N2O
Gas equilibrates early along capillary Diffusion can be increased only if blood flow increases |
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Molecules that are diffusion limited
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CO, O2 (emphysema, fibrosis)
Gas does not equilibrate by the time blood reaches end of capillary |
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Pulmonary hypertension
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> 25 mmHg in pulm artery
normally 10-14 mmHg 1 - unknown etiology, poor prognosis smooth mm hypertrophy, fibrosis of intima, inc endothelial cells Rx - Bosentan 2 - usually caused by COPD, can also be caused by L--> R shunt |
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Pulmonary vascular resistance equation
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PVR = (pulm artery pressure - left atrium (PCWP) ) / CO
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Oxygen content
Oxygen delivery |
O2 content = (O2 binding capacity x % saturation) + dissolved O2
O2 delivery to tissues = CO x O2 content of blood |
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Alveloar gas equation
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PAO2 = 150 - (PaCO2/ 0.8)
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Haldane effect
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oxygenation of Hb promotes dissociation of H+ from Hb
Shifts equilibrium toward CO2 formation, so CO2 is releasd form RBCs |
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Bohr effect
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In peripheral tissue, H+ from tissue metabolism shifts curve to right unloading O2
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Responses to high altitude
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Acute/Chronic increase in ventilation
Inc erythropoietin resulting in increased Hct and Hgb Inc 2,3 DPG (inc unloading) Cellular changes (inc mitochondria) Inc renal excretion of bicarb to compensate for respiratory alkalosis Chronic hypoxic pulm vasoconstriction results in RVH |
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PFT changes seen in obstructive lung disease
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obstruction of air resuling in air trapping in lungs
airways close prematurely at high lung volumes Inc RV, dec FVC DEc FEV/FVC < 80% V/Q mismatch |
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Chronic bronchitis
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Blue bloater
hypertrophy of mucus-secreting glands in bronchioles Reid index = gland depth/total thickness of wall here, > 50% Productive cough for > 3 consecutive months in > 2 years Disease of small airways Wheesing, crackles, cyanosis |
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Emphysema
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Pink puffer - barrel-shaped chest
Enlargement of air spaces and dec recoil resulting from destruction of alveolar walls Centriacinar - caused by smoking Panacinar - alpha-antitrypsin deficiency Paraseptal emphysema - associated with bullae - can rupture, cause spontaneous pneumothorax in young, otherwise healthy males lung compliance due to loss of elastic fibers. exhale through pursed lips to increase airway pressure and prevent airway collapse during exhallation dyspnea, dec breath sounds, tachycardia, dec I/E ratio |
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Asthma
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Bronchial hyperresponsiveness causes reversible bronchoconstriction
Smooth muscle hypertrophy and Curschmann's spirals (shed epithelium from mucus plugs) Triggered by viral URIs, allergens, stress Cough, wheezing, dyspnea, tachypnea, hypoxemia, Dec I/E ratio, pulsus paradoxus, mucus plugging |
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Bronchiectasis
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Chronic necrotizing infection of bronchi:
permanently dilated airways, prurulent sputum, recurrent infections, hemoptysis Assoc w/ bronchial obstruction, CF, poor ciliary motility, Kartagener's. can develop aspergillosis |
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Restrictive lung disease
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Dec lung volumes - FVC, TLC
FEV/FVC > 80% Due to: 1. Poor breathing mechanics - extrapulmonary, peripheral hypoventilation - poor muscular effort, poor structural apparatus 2. Interstitial lung diseases (pulmonary, lowered diffusing capacity) - ARDS, NRDS, pneumoconiosis, sarcoidosis, IPF, Goodpasture's, Wegener's, eosinophilic granulomas (histiocytois X), drugs |
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Beta agonists used in the treatment of asthma
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Isoproterenol - nonspecific - relaxes bronchial smooth muscle b2, tachycardia b1
Albuterol - b2 selective, use in acute exacerbation Salmeterol - long acting agent for prophylaxis. adverse effects - tremor, arrhythmia |
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Methylxanthines
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Theophylline - likely causes bronchodilation by inhibiting phosphodiesterase, decreasing cAMP
narrow therapeutic index p450 metabolism |
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Muscarinic agonist used for asthma
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Ipratopium - competitive block of muscarinic receptors, preventing bronchoconstriction
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Corticosteroids used for asthma
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Beclomethasone, prednisone - inhibit the synthesis of all cytokines by inactivating NFkB
First line for chronic asthma |
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Antileukotrienes used for asthma
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Zileuton - a 5 - lipoxgenase pathway inhibitor.
Blocks conversion of arachadonic acid to leukotrienes Zafirlukast, montelukast - block leukotriene receptors. Especially good for aspirin-induced asthma |