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121 Cards in this Set
- Front
- Back
A patient exhibits an extended expiratory phase; what is the disease process?
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obstructive lung disease
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Tall, thin teenage male has abrupt-onset dyspnea, left sided chest pain, reduced breath sounds, and hyperresonace. What happened?
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Spontaneous pneumothorax
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Young women can't conceive, suffers from recurrent URI's, and has dextrocardia. What is her problem?
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Kartagener's syndrome (mutated dynein protein)
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What is the TLC of a person with these lung volumes: FRC=5, IRV=1.5, IC=2, VC =3.5
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7
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Preterm infant has increased lung density on Xray and difficulty breathing. What's wrong, and what could have prevented it?
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neonatal respiratory distress syndrome. Give mom steroids before birth to increase fetal surfactant production
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25-year old comatose dude on a ventilator dies from fever, had a pus-filled cavity in his lung. What happened?
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He aspirated infective material and it led to a lung abscess
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52-yr-old woman undergoing menopause is tired. What's the dx and has her O2 sat and O2 content changed?
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anemia due to blood loss. O2 sat is unchanged, O2 content is decreased
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Patient has hypoxia, but a normal chest X-ray. What's the cause?
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Pulmonary embolism
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What disease can a pulmonary embolism mimic?
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myocardial infarction
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Patient has hypoxia, and enlarged heart on chest X-ray. What's the cause of the hypoxia?
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CHF
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Which anatomical structures are part of the conducting zone of the respiratory tree?
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everything from the nose/mouth down to the terminal bronchioles. Only moves air, no gas exchange
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Cartilage is present only in the ________ and _________ of the respiratory tree
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trachea and bronchi
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Which anatomical structures are part of the respiratory zone of the respiratory tree?
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respiratory bronchioles, alveolar ducts, and alveoli. They all exchange gases.
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What is the lecithin/sphingomyelin ration used for?
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A value of >2 in the amniotic fluid indicates that the fetus has mature lungs
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Which cell type lines the alveolar surface, and is thin to facilitate gas exchange?
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Type 1 pneumocyte
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Which cells are cuboidal, secrete surfactant, and proliferate when the lung is damaged?
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Type II pneumocyte
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Which cells secrete components of surfactant, and also degrade toxins in the respiratory tree?
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Clara cells
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Where are the vessels in any given broncho-pulmonary segment?
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Bronchial and pulmonary arteries run with the bronchus, veins and lymphatics run along the margins
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If I inhaled a grape, which lung would it end up in and why?
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Right lung, because the right mainstem bronchus is wider and more vertical than the left one
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Where are the pulmonary arteries in relation to the mainstem bronchi at the hilum?
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Right artery is anterior to the bronchus, left artery is superior to the bronchus
(RALS) |
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The fissure between the superior lobe and the middle lobe of the right lung corresponds to what other structure?
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4th rib
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At what vertebral level does the IVC penetrate the diaphragm?
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T8
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At what vertebral level does the esophagus penetrate the diaphragm?
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T10
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At what vertebral level does the aorta penetrate the diaphragm?
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T12
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Pain in the diaphragm can feel like pain from....where?
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Your shoulder
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Which muscles control breathing during quiet respiration?
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inspiration - diaphragm
expiration - passive |
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Which muscles control breathing during exercise?
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inspiration - external intercostals, scalenes, sternomastoids
expiration - abdominals, internal intercostals |
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What 3 things does surfactant do?
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decrease alveolar surface tension, increase lung compliance, decrease work of inspiration
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Lung volumes: tidal volume (TV)?
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air that moves into and out of lungs during a normal, quiet breath
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Lung volumes: expiratory reserve volume (ERV)?
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air that can be breathed out after a normal exhalation
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Lung volumes: Inspiratory reserve volume (IRV)?
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air in excess of tidal volume that you can breath in on maximum inspiration
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Lung volumes: Residual volume (RV)?
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air left in the lung after maximal expiration
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Lung volumes: Vital Capacity (VC)?
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TV+IRV+ERV
or, the total amount of usable lung volume |
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Lung volumes: Functional Residual Capacity (FRC)?
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ERV+RV
or, total air left in the lung after a normal, quiet expiration |
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Lung volumes: Inspiratory capacity (IC)?
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TV+IRV
or, total amount of air you can breath in after a normal, quiet expiration |
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Lung volumes: Total Lung Capacity (TLC)?
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IRV+TV+ERV+RV
or, total amount of air that your lungs can hold |
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What is the formula for determining the physiologic dead space?
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TV x (PA-PE) / PA
TV=tidal volume PA=arterial pCO2 PE=expired air pCO2 |
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In plain english, what does it mean when the oxygen-hemoglobin curve is moved to the left?
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hemoglobin holds on to oxygen tighter
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What can cause the oxygen-hemoglobin curve to move to the left?
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lower temperature, lower pCO2, higher pH, lower 2,3DPG, fetal hemoglobin, resting
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What can cause the oxygen-hemoglobin curve to move to the right?
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higher temperature, higher pCO2, lower pH, higher 2,3DPG, exercising
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In plain english, what does it mean when the oxygen-hemoglobin curve moves to the right?
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Hemoglobin doesn't hold on to oxygen very tightly; O2 moves into tissues easier
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The pulmonary circulation is normally a ______-resistance, _______-compliance system
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low resistance, high compliance
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Hypoxia (decreased O2) in lung tissue leads to....what?
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local vasoconstriction, to shunt blood to other places where there is more oxygen
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What does it mean to say that O2 transport is perfusion-limited in pulmonary capillaries?
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O2 equilibriates almost instantaneously; to increase diffusion, you must increase blood flow
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What does it mean to say that in certain disease states, O2 transport is diffusion-limited in pulmonary capillaries?
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O2 does not equilibriate by the time the blood leaves the capillary due to fibrosis or scarring
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What are the 2 problems with CO poisining?
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CO left-shifts the oxyHgb curve (less tissue offloading) and has 50% more affinity to bind to HgB
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How do you treat CO poisining?
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100% oxygen
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Normal pulmonary artery pressure is.....?
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10-14 mmHg
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What are the cutoffs for pulmonary hypertension?
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at rest: >25mmHg
excercise: >35mmHG |
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What causes primary pulmonary hypertension?
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Nobody knows, and it carries with it a really bad prognosis
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What causes secondary pulmonary hypertension?
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COPD, usually, but can also be caused by a L->R shunt
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How does airway resistance relate to length and radius of the vessel?
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resistance increases with increased length, decreases a lot with increased radius
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What is the equation for Pulmonary Vascular Resistance (PVR)?
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(pulmonary artery pressure - pulmonary wedge pressure) / cardiac output
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What is the O2 binding capacity in a normal person?
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20.1 mL oxygen per deciliter
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What is the equation for total oxygen content of the blood?
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(O2 binding capacity x %saturation) + dissolved O2
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What is the formula for oxygen delivery to tissues?
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cardiac output x blood oxygen content
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What is the Alveolar Gas Equation?
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pAO2=pIO2-(pACO2 / R)
pAO2=oxygen in the alveolus pIO2=oxygen in inspired air pACO2=CO2 in the alveolus R=respiratory quotient |
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What can you use as an easier approximation of the Alveolar Gas Equation?
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PAO2=150-(PaCO2 / 0.8)
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What is a normal Alveolar-arterial (A-a) gradient?
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10-15 mmHg
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What does it mean if the A-a gradient is elevated?
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hypoxemia due to shunting, V/Q mismatch, or fibrosis
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How do you calculate the A-a gradient?
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pAO2-paO2
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What does a very very small V/Q ratio mean?
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Shunt. Lots of perfusion, not much ventilation. 100% O2 does NOT improve pO2
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What does a very very large V/Q ratio mean?
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Dead Space. Not much perfusion, lots of ventilation. 100% O2 improves pO2
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Identify the 3 lung zones in terms the V/Q ratio
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Zone 1 -> V/Q=3, at the apex
Zone 2-> V/Q=1, in the middle Zone 3-> V/Q=0.6, at the base |
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What are the 3 ways carbon dioxide is transported from tissues?
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As bicarb (90%)
bound to Hgb (5%) dissolved in plasma (5%) |
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What are the body's responses to living at high altitude?
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increased ventilation, increased hematocrit, increased Hgb, increased 2,3DPG, increased bicarb excretion
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In general, what happens in obstructive lung disease?
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increased residual volume, decreased vital capacity. decreased FEV1, decreased FEV1/FVC ratio. V/Q mismatch.
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In plain english, what happens in obstructive lung disease?
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You breath air in, but the air can't get out. Lung compliance is high, lung elasticity is low
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What happens in Chronic Bronchitis?
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hypertrophy of mucus-secreting glands, increase in thickness of small airway walls.
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what is the timeframe for diagnosing Chronic Bronchitis?
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productive cough for longer than 3 consecutive months in more than 2 years
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What happens in emphysema?
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Destruction of alveolar walls leads to enlarged, floppy airspaces
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What are some symptoms of Chronic Bronchitis?
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wheezing, crackles, cyanosis
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What are some symptoms of emphysema?
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dyspnea, decreased breath sounds, tachycardia, pursed lips
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What causes centriacinar emphysema?
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smoking
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What causes panacinar emphysema?
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alpha1-antitrypsin deficiency
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What's special about paraseptal emphysema?
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Cause bullae (air bubbles) that can rupture and lead to pneumothorax. Happens in otherwise healthy young males
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What happens in asthma?
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bronchi constrict at the drop of a hat. Smooth muscle hypertrophy. Triggered by allergies, stress, viruses.
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What are some symptoms of asthma?
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cough, wheezing, dyspnea, tachypnea, hypoxemia, pulsus paradoxus, mucus plugs
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What happens in bronchiectasis?
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necrotizing infection that leads to permanently dilated airways.
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What are some symptoms of bronchiectasis?
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recurrent infections, purulent sputum, hemoptysis
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What other syndromes can lead to bronchiectasis?
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Cystic fibrosis, Kartagener's syndrome, poor ciliary motility
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In general, what happens in Restrictive Lung Diseases?
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Lungs can't expand. FEV1/FVC ratio is greater than 80%. reduced total lung volume
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What two general categories do restrictive lung disease fall into?
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those due to musculoskeletal problems, and those due to inherent problems with the lung
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Polio and myasthenia gravis can lead to what kind of lung disease?
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restrictive lung disease due to poor muscular support
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Scoliosis and morbid obesity can lead to what kind of lung disease?
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restrictive lung disease due to structural support issues
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Give some examples of inherent restrictive lung diseases
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ARDS, chemical inhalation, sarcoid, goodpasture's, Wegener's, pulmonary fibrosis, hyaline membrane disease
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What causes neonatal respiratory distress syndrome? (also called hyaline membrane disease, I don't know why)
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lack of surfactant. Lung alveoli collapse in on themselves
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What happens in ARDS?
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injury leads to protein leakage into alveolar space. Neutrophils cause damage, hyaline membranes form
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What is the normal value for the FEV1/FVC ratio?
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80%
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A person has focal absent breath sounds, decreased resonance and fremitus, and his trachea deviates toward the affected side. What's his problem?
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obstructed bronchus
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A person has decreased focal breath sounds, dull percussion, decreased fremitus, and no tracheal deviation. What's her problem?
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pleural effusion
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A person has normal breath sounds, dull percussion, increased fremitus, and no tracheal deviation. What's their problem?
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Lobar pneumonia
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A person has decreased breath sounds, hyperresonant percussion, absent fremitus, and the trachea deviates away from the affected side. What is the problem?
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pneumothorax
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Where does Squamous cell carcinoma occur, and what causes it?
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central tumors in the hilum. You'll see cavitations. Caused by smoking.
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Where does adenocarcinoma occur, and what kind of cells give rise to it?
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peripheral sites of prior injury, arises from both type 2 pneumocytes and clara cells. Not linked to smoking
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Where does Small Cell Carcinoma occur, and what's the pathology?
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central location, aggressive, undifferentiated. Comes from neuroendocrine cells. Treat with chemo
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Where does Large Cell Carcinoma occur, and what's the pathology?
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peripheral location, undifferentiated, poor prognosis. Treat with surgery
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What kind of tumor can secrete serotonin and cause flushing, diarrhea, wheezing, and salivation?
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Carcinoid tumor
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What cancers commonly metastatize to the lung?
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brain, bone, and liver
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What tumor occurs in the apex of the lung, and can cause Horner's syndrome?
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Pancoast's Tumor
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Which pneumonia presents with intra-alveolar exudate and consolidation on chest X-ray? What organism causes it?
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Lobar pneumonia, usually caused by pneumococcus
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Which pneumonia presents with inflammation starting in bronchioles and moving in to the alveoli in a patchy distribution?
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Bronchopneumonia
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What organisms commonly cause bronchopneumonia?
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S aureus, H flu, Klebsiella, S pyogenes
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Which pneumonia causes diffuse patchy inflammation in the interstitium, leaving the alveoli alone?
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Interstitial (atypical) pneumonia
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What organisms commonly cause interstitial pneumonia?
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RSV, adenovirus, mycoplasma, legionella, chlamydia
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What organisms are usually found in lung abscesses?
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S aureus or anaerobes
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What are the 2 most common causes of lung abscess?
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bronchial obstruction due to a tumor, or aspirated gastric contents
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What's the difference between a transudate and an exudate?
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Transudate has low protein content and is mostly clear, exudate has high protein content and is mostly cloudy
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What are some common causes of a trandudative pleural effusion?
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CHF, nephrotic syndrome, hepatic cirrhosis
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What are some common causes of an exudative pleural effusion?
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malignancy, pneumonia, collagen vascular disease, trauma
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how does isoproterenol work and what is it used for?
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treats asthma by relaxing bronchial smooth muscle. It's a beta-agonist
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How does albuterol work, and what is it used for?
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treats asthma by relaxing bronchial smooth muscle. Very fast acting, you inhale it.
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How does salmeterol work, and what is it used for?
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treats asthma by relaxing bronchial smooth muscle. Long-acting, used prophylactically
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how does theophylline work, and what is it used for?
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treats asthma by inhibiting phosphodiesterase -> increasing bronchodilation. Toxic to heart and nerves.
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How does ipratropium work, and what is it used for?
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treats asthma by blocking muscarinic receptors, preventing bronchoconstriction
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How does cromolyn work, and what is it used for
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treats asthma by inhibiting mast cell effectors. Prophylaxis only, useless for an acute attack
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Why do you give corticosteroids (beclomethasone, prednisoe) to people with asthma?
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they prevent the inflammation that causes the long-term thickening and damage to the bronchial wall
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how does zileuton work, and what is it used for?
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treats asthma by blocking the conversion of arachidonic acid into leukotrienes. Reduces inflammation
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How do zafirlukast and montelukast work, and what are they used for?
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treats asthma by blocking leukotriene receptors, therefore lessening the inflammatory response
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What is guaifenesin used for, and what does it do?
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removes excess phlegm, but does NOT suppress the cough reflex
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What is N-acetylcysteine, and who is it given to?
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It's a mucolytic, and is given to CF patients
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