Ashton Shared "RSM - Pulmonary Pathology" - 63 Picmonics

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RSM - Pulmonary Pathology

Physiologic Dead Space (VD)
Tidal Volume (VT)
Partial pressure of arterial CO2 (PaCO2)
Partial pressure of CO2 in expired air (PECO2)
VD = TV x (PaCO2-PECO2) / PaCO2
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A-a Gradient
Partial pressure of alveolar oxygen (PAO2)
Partial Pressure of Arterial O2 (PaO2)
Normal 10 to 15 mmHg
Hypoxemia with an Abnormal A-a Gradient
Diffusion problem
Shunting (Low V/Q)
Dead space (high V/Q)
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1 min
Circadian Rhythm
Suprachiasmatic Nucleus
25 hours
Retino-hypothalamic Tract
Glutamate (for daytime)
Melatonin (for night)
Genes
CLOCK (CLK) & BMAL1
Per1,2,3 & Cry1,2
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Sleep Induction
Ventral Pre-Optic (VPO) Region
Prostaglandin/Adenosine
Prostaglandin D2 in Periphery
DP Receptor (PGD2R) on Leptomeninges
Adenosine in CSF
Adenosine 2a (A2a) Receptor
Cytokines/Hormones
IL-1-beta
TNF-alpha
GHRH
NF-kappa-beta
NOS (Nitric Oxide Synthase)
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Initiation of REM Sleep
Initiation of REM
Lateral Pontine Tegmentum
Acetylcholine
Geniculate Body
Occipital Cortex
Muscle Paralysis
Locus Ceruleus
Alpha-Motoneuron
Paralysis
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Arousal from Sleep
Lateral Hypothalamus
Orexin A&B (Hypocretin 1&2)
Tuberomamillary Nucleus
Histamine
Locus Ceruleus
Norepinephrine
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Sleep Cycle
NREM (N1, N2, N3)
⬆ Amplitude, ⬇Frequency
N1: Drowsiness, Muscle activity
N2 (True Sleep): ⬇ Muscle activity
Sleep Spindles (burst of alpha)
K complex: Sharp wave preceding Sleep Spindle
N3 (Deep Sleep): ⬆ Amplitude, ⬇Frequency
Theta and Delta waves
REM
⬇ Amplitude, ⬆ Frequency
Beta waves
Most easily aroused
90 Minute Cycles (1st=70-100m)
Each cycle ⬆REM ⬇N3
Children ⬆REM ⬆N3 ⬆Sleep
Elderly: fewer but longer REM, No N3, ⬇Sleep
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EEG Waveforms
General
Low Voltage (<200 µV)
Frequency (<1 Hz to >50Hz)
No distinct pattern
Increased Mental Activity = Increased EEG Activity
But eyes open = desynchronization & reduced amplitude
Infancy = slower waves (Beta) predominate
Alpha wave appears in Adolescence
Waveforms
Alpha Waves
Quiet Wakefulness (eyes closed)
8-13 Hz; 50 µV
GABAergic Neruons b/t Occipital Cortex and Thalamus
Beta Waves
Alert Wakefulness (eyes open)
14-80 Hz; <50 µV
Block Alpha Waves
Frontal (& Parietal) Cortex and Thalamus
Gamma Waves
Aroused (Focused) or Planning (Imagining)
30-80 Hz
Hippocampus
Theta Waves
Frustration/Disappointment/Sleeping (adults) or Children
4-7 Hz; 100 µV
Parietal & Frontal Cortex
Hippocampus
Delta Waves
Deep Sleep (adults) or Infants
<3.5 Hz; 100-200 µV
Dissociation of Cortex and Thalamus
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Croup (Laryngotracheobronchitis)
Mechanism
Parainfluenza Virus
Assessment
3 Months to 3 Years
Nighttime
Barking Seal Cough
Inspiratory Stridor
Interventions
Cool Humidified Air
Dexamethasone
Racemic Epinephrine
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Acute Respiratory Distress Syndrome (ARDS) Assessment
Cause
Damaged Alveolar-Capillary Membrane
Assessment
Restlessness
Dyspnea
Refractory Hypoxemia
Decreased PaO2
Diffuse Pulmonary Infiltrates
Atelectasis
Pulmonary Hypertension
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Acute Respiratory Distress Syndrome (ARDS) Interventions
Interventions
Closely Monitor Patient
ABG's (Arterial Blood Gases)
Oxygen
Assess for O2 Toxicity
Mechanical Ventilation
PEEP
Assess for Pneumothorax
Permissive Hypercapnia
Considerations
High Mortality Rate
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Restrictive vs. Obstructive Lung Diseases
Restrictive Lung Disease
Decreased Lung Volume
FEV1/FVC Ratio Normal to Increased
Obstructive Lung Disease
Increased Lung Volume
Decreased FEV1/FVC Ratio
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Restrictive Lung Diseases
Poor Breathing Mechanics
Interstitial Lung Diseases
Goodpasture's Syndrome
Eosinophilic Granuloma
Granulomatosis with Polyangiitis
Sarcoidosis
Pneumoconiosis
Idiopathic Pulmonary Fibrosis
Drug Toxicity
Acute Respiratory Distress Syndrome (ARDS)
Neonatal Respiratory Distress Syndrome
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Obstructive Lung Disease
Blocked Airflow
Increased residual volume
V/Q Mismatch
Decreased forced vital capacity (FVC)
Decreased FEV1/FVC ratio
Asthma
Bronchiectasis
Chronic bronchitis
Emphysema
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Emphysema
Clinical Features
Pink Puffer
Exhale through Pursed Lips
Barrel Chest
Pathophysiology
Obstructive Lung Disease
Increased Lung Compliance
Types
Centriacinar
Panacinar
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Chronic Bronchitis
Pathophysiology
Chronic Inflammation of Bronchi
Signs and Symptoms
Early-Onset Cyanosis
Blue Bloaters
Productive Cough
Wheezing
Chronic Obstructive Pulmonary Disease (COPD)
Late-Onset Dyspnea
Crackles
Diagnosis
Reid Index > 50%
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Asthma
Obstructive lung disease
Bronchial Hyperresponsiveness
History of Atopic Disease
Beta2 agonists
Corticosteroids
Curschmann's spirals
Hypertrophy of smooth muscle
Reversible
Charcot Leyden crystals
Methacholine challenge
Wheezing
Cough
Initially decreased PaCO2
Pulsus paradoxus
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2 mins
Bronchiectasis
Obstructive Lung Disease
Chronic Necrotizing Infection
Permanent Airway Dilation
Poor Ciliary Motility
Kartagener's Syndrome
Cystic Fibrosis
Allergic Bronchopulmonary Aspergillosis
Hemoptysis
Increased Sputum
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Cystic Fibrosis Mechanisms
Autosomal Recessive
CFTR chromosome 7
Cl- channel defect
Decreased chloride secretion
Increased Na and water reabsorption
Increased Na and Cl in sweat
Dehydration of mucous layers
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Cystic Fibrosis Symptoms and Complications
Recurrent Pulmonary Infections
Chronic Bronchitis
Nasal Polyps
Pancreatic Insufficiency
Intestinal Obstruction
Malabsorption and Diarrhea
Vitamin Deficiencies
Chronic Hepatic Disease
Infertility in Males
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1 min

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