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
2 mins
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)
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
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)
Initiation of REM Sleep
- Initiation of REM
- Lateral Pontine Tegmentum
- Acetylcholine
- Geniculate Body
- Occipital Cortex
- Muscle Paralysis
- Locus Ceruleus
- Alpha-Motoneuron
- Paralysis
Arousal from Sleep
- Lateral Hypothalamus
- Orexin A&B (Hypocretin 1&2)
- Tuberomamillary Nucleus
- Histamine
- Locus Ceruleus
- Norepinephrine
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
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
Croup (Laryngotracheobronchitis)
- Mechanism
- Parainfluenza Virus
- Assessment
- 3 Months to 3 Years
- Nighttime
- Barking Seal Cough
- Inspiratory Stridor
- Interventions
- Cool Humidified Air
- Dexamethasone
- Racemic Epinephrine
2 mins
Acute Respiratory Distress Syndrome (ARDS) Assessment
- Cause
- Damaged Alveolar-Capillary Membrane
- Assessment
- Restlessness
- Dyspnea
- Refractory Hypoxemia
- Decreased PaO2
- Diffuse Pulmonary Infiltrates
- Atelectasis
- Pulmonary Hypertension
2 mins
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
2 mins
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
2 mins
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
2 mins
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
51 secs
Emphysema
- Clinical Features
- Pink Puffer
- Exhale through Pursed Lips
- Barrel Chest
- Pathophysiology
- Obstructive Lung Disease
- Increased Lung Compliance
- Types
- Centriacinar
- Panacinar
2 mins
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%
2 mins
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
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
2 mins
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
2 mins
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
1 min
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