Module 3/4: Physiology Of The Respiratory System

Question 1

Review: Proteins structure

Answer 1

• Building blocks: Amino acids (20 standard AAs)

• Sequence of AAs (primary structure):
— Based on genetic information (DNA mRNA  polypeptide)

• Properties of R-group of amino acids determines the
three-dimensional structure of polypeptides
— Secondary structure: Common motifs (-helix, -sheet)
— Tertiary structure: Most stable 3-D arrangement of a
polypeptide

Quaternary structure: 3-D arrangement of multiple
polypeptides in multi-subunit proteins • The structure is optimized to serve a specific
function

Question 2

Globular Proteins
Review

Answer 2

Very diverse, with respect to • Structure
• The structure is optimized to serve a specific function • Function
• Enzymes
• Ligand-binding proteins (e.g., hemoglobin – binding oxygen)
• Regulatory proteins (e.g., insulin)
• Stabilizing proteins

Globular proteins are compact, water-soluble proteins that perform a wide range of vital functions in the body. They act as transporters, such as hemoglobin, which carries oxygen in the blood. Many globular proteins function as enzymes, like amylase, which helps break down starch during digestion. They also play a key role in defense, with antibodies protecting the body against infections. Some, like insulin, act as regulators by controlling processes such as blood sugar levels, while others, like actin and myosin, are involved in movement by enabling muscle contraction. Their diverse roles make globular proteins essential to nearly every biological process.

Question 3

Ligand-Binding Proteins
Review

Answer 3

• Ligand:
— Binds at a specific site that is complementary to the shape of the
ligand (lock and key analogy: Binding site = lock, ligand = key)
— Not covalently bound • Proteins can have multiple binding sites for the same ligand (e.g.,
hemoglobin)
— Proteins can have multiple binding sites for multiple ligands (each
uniquely complementary to the ligand)
— Purpose of ligands:
—Reason for need of protein (e.g., storage or transport of oxygen, storage of
minerals)
— Allosteric regulation (e.g., BPG affecting hemoglobin)

Question 4

The Process of Ligand-Binding

Ligands are molecules that bind to another molecule, usually a larger one like a protein (often a receptor or enzyme). The binding is usually specific — like a key fitting into a lock.

Answer 4

Equilibrium between free protein (P) and
P + L ligand (L) and protein-ligand complex
(PL) PL

• LeChâtelier principle:
— Add more ligand —> equilibrium shifts toward
more PL
— Remove ligand —> equilibrium shifts away
from PL side of equation to free P and L

Le Châtelier’s Principle states that when a system at equilibrium is disturbed, it will adjust (shift) to counteract the disturbance and re-establish equilibrium.

Relationship to ligand-binding =

You’re plotting how much PL forms at different ligand concentrations.

At high [L]: Most protein is bound to ligand → [PL]/[P]total approaches 1 (100%).
At low [L]: Few protein-ligand complexes → [PL]/[P]total is near 0.

*** Le Châtelier’s Principle helps you predict which way the binding shifts.
Adding ligand → more PL forms.
Removing ligand → PL breaks apart.
The binding curve shows how much PL is formed depending on how much ligand you add.

• Graph:
— Y: Number of PL out of total P(1 = 100%)
— High [L]  more PL
— Low [L]  less PL

• Kd
— = [L] when 50% of binding sites are
occupied
— Gives a measure of affinity of the protein
(the binding site) for ligand

Question 5

The Relationship between Kd and Affinity

*slide 8

Answer 5

• A and B are different proteins that bind the same ligand
• A has a Kd of 2 M • B has a Kd of 6 M
• A has a higher affinity for L than B
• General statements:
• Low Kd means high affinity for the
ligand
• High Kd means low affinity for the
ligand

** look at graph

Question 6

What is the Desired Kd? (Kd and affinity explained further)

Answer 6

• It depends on the function of the
protein and the ligand
• It has been optimized to best serve
the function
• Depends on the structure of the
protein (primary – quaternary)

Kd (dissociation constant) is a measure of how tightly a ligand (e.g. a drug, hormone, or antibody) binds to its target (e.g. a receptor or enzyme).
It represents the concentration of ligand at which half of the available binding sites are occupied.

Affinity refers to the strength of the interaction between a ligand and its binding partner.
Lower Kd → Higher affinity
Higher Kd → Lower affinity

If a ligand binds very tightly (high affinity), it dissociates slowly and has a low Kd.
If it binds weakly (low affinity), it dissociates quickly and has a high Kd.

Question 7

High affinity means _____ Kd

Low affinity means ____ Kd

Answer 7

Low

High

Question 8

The Structure of Heme

Fe+2 ion attracts ?

Answer 8

O2

• Fe2+ had one electron in outermost
shell that can easily be removed to form Fe3+
• O2 LOVES electrons (is a strong
oxidizing agent)

Question 9

Oxygen (O₂) binding to hemoglobin induces a conformational change between two major states:

Tense State:
Relaxed state:

Answer 9

Tense (T) state:
Low affinity for O₂
Stabilized when O₂ is absent
Hemoglobin is more rigid due to more salt bridges

Relaxed (R) state:
High affinity for O₂
Stabilized when O₂ binds
Binding of O₂ to one subunit breaks salt bridges, causing a shift in quaternary structure that makes it easier for other subunits to bind O₂ (cooperative binding)

O₂ binding shifts hemoglobin from the T state (low affinity) to the R state (high affinity), enhancing further O₂ uptake through positive cooperativity.

T state = clamp is tight, hard to open (hard to bind O₂).
Once one O₂ binds, it loosens the clamp → R state → easier for more O₂ to bind.

SUMMARY:
🔴 Tense (T) State
Low affinity for oxygen
Hemoglobin is in this form before oxygen binds
The structure is tight, making it harder for O₂ to bind
🟢 Relaxed (R) State
High affinity for oxygen
When one oxygen molecule binds, hemoglobin changes shape (conformational change)
This makes it easier for more oxygen to bind — a process called cooperative binding

Oxygen binding to hemoglobin causes a conformational change from the T state to the R state, increasing its ability to bind more oxygen efficiently.

**Cooperative Binding

After a Heme group binds its first O 2 molecule…..the hemoglobin molecule
changes shape that increases the ability to bind the second O 2 molecule • When it binds the second O 2 molecule….it changes shape again to increase
the ability to bind the third O2 molecule

Question 10

Hemoglobin functions optimally in the lungs as a _____ affinity protein and in the tissue as a ___ affiliate protein

Answer 10

High

Low

In the lungs, where oxygen levels are high, hemoglobin has a high affinity for oxygen — it binds oxygen tightly.

In the tissues, oxygen levels are low, so hemoglobin’s affinity decreases, and it releases oxygen.

Question 11

Myoglobin: _________ curve

Answer 11

Hyperbolic

• Higher affinity than hemoglobin
• Optimized for storage
• Monomer

Myoglobin: Hyperbolic Curve

Binds oxygen quickly and strongly
Has high affinity, even at low O₂ levels
No cooperativity (binds just one O₂ molecule)
Curve shape: Smooth and hyperbolic

Question 12

Hemoglobin: _________ curve

Answer 12

Sigmoid

• At low pO2: low affinity
• At high pO2: high affinity
• Optimized for transport
• Tetramer

Shows cooperative binding: binding one O₂ makes it easier to bind the next
Curve shape: Sigmoid (S-shaped) due to T → R state transition
Allows hemoglobin to pick up oxygen in the lungs (high O₂) and release it in tissues (low O₂)

Question 13

Transfer of O2 from Hemoglobin to Myoglobin

Answer 13

• Myoglobin: P50 ≈ 0.1 kPa
• Hemoglobin: P50 ≈ 2.6 kPa

• The oxygen not used in muscle
tissue will move from the protein
with the lower affinity to the
protein with the higher affinity

• O2 will be released from Mb,
when muscle close to anaerobic
(back up system for low O2
situations)

Question 14

The steeper the curve on a graph = higher the _____

Answer 14

Affinity

Lower the curve = lower affinity

Question 15

Effect of pH O2-Binding by Hb

Answer 15

• The higher the pH, the
higher the affinity
(lowest P50)

or

• The lower [H+], the
higher the affinity
(low [H+]  high pH

Becuase higher pH means its less acidic
High H+ means its more acidic

Question 16

What is affinity?

Answer 16

High affinity = hemoglobin strongly binds to oxygen and holds onto it.

Low affinity = hemoglobin binds oxygen weakly and is more likely to release it.

Question 17

Release of CO2 into a solution leads to an _______ in [H+] and thus a ______ in pH

Answer 17

Increase in H+

Decrease in pH

1. CO₂ is released by cells during metabolism.
2. In the blood, CO₂ reacts with water to form carbonic acid (H₂CO₃).
3. Carbonic acid dissociates into:
   Hydrogen ions (H⁺)
   Bicarbonate ions (HCO₃⁻)
4. More H⁺ = lower pH, because pH is a measure of hydrogen ion concentration.

pH is inversely related to H⁺ concentration.

So, as CO₂ increases, more H⁺ is produced → pH drops (becomes more acidic).

Question 18

pH Change Leads to More Release of O2

Best function of Hb:

Answer 18

• In lungs: High affinity preferred to get as much as possible O2 picked up
—>High pH means higher affinity

• In tissue: Low affinity preferred to get more O2 delivered for cellular respiration —> Low pH means lower affinity

Low pH (acidic, high H⁺) → hemoglobin releases O₂ more easily

High pH (alkaline, low H⁺) → hemoglobin holds on to O₂ more tightly

What Happens in High pH (Alkalosis)?
1. Less H⁺ in the blood
2. Hemoglobin stays in the R (relaxed) state, with high affinity for oxygen
3. It binds oxygen well in the lungs but doesn’t release it easily in tissues
4. Result: Poor oxygen delivery where it’s needed

Question 19

Adapting to High Altitude: Short- and Longterm

Answer 19

• High altitude:
—‘Thin air’  pO2 lower than at sea level
—Less O2 available
—> feeling tired, low energy, potentially altitude sickness (headache, nausea)

• Within 24-48 hours: —Increase in BPG
—> Net supply of O2 increases to approximately ‘normal’ levels —> Less O2 reserves for ‘fight or flight’ situations

• After several weeks:
— Increase in O2 reserves through an increase in Hb molecules via an increase in
red blood cells (BPG drops back to 5 mM)

Question 20

Effect of Carbon Monoxide Poisoning

Answer 20

Carbon monoxide (CO) competitively binds at O2-binding site, but forms a much stronger bond than O2

Since CO is tightly bound,
• Fewer binding sites are available to bind O2
• The switch to the low-affinity state is not happening,
as some binding sites continue to carry a ligand
—> Very little oxygen is released in the tissue <10%
• The effect of CO-poisoning:
Increase in affinity (lowering of P50, steeper curve)

Question 21

Micronutrient Deficiencies Affecting Hemoglobin

Answer 21

Deficiency in

• Iron: —> Iron-deficiency anemia

• Folate and Vitamin B12: —> Megaloblastic anemia
Large, oval-shaped erythrocytes; some nucleated
erythrocytes (these deficiencies affect DNA replication)

• Vitamin A and C, zinc: —>can contribute to anemia or make
symptoms worse

Question 22

T or F

Anemia does not affect the affinity of hemoglobin itself for oxygen

Answer 22

T

Question 23

In fetal hemoglobin vs adult hemoglobin

Fetal hemoglobin (HbF) has a ______ affinity, lower P50

Answer 23

Higher

Oxygen moves form the lower affinity protein to the higher affinity protein

Question 24

Fetal Hemoglobin (HbF) vs Adult Hemoglobin (HbA)

Answer 24

The basis for the altered function is a
different structure:
• Consists of 2 a- (alpha)and 2 y-subunits (gamma); the subunit is
encoded on a different gene and has a slightly
different primary structure than the —> subunit
• There is no binding site for BPG

Replaced with HbA within a few months of birth as the red blood cells are replaced (the gene for the y-subunit becomes suppressed and the gene for the beta-subunit is activated)

Question 25

Sickle Cell Disease: Effect of Mutation

Answer 25

• Amino acid #6 is typically buried inside of the globular subunits • In physical exertion or during an infection, more oxygen is required in certain tissues, which leads to some HbS becoming completely deoxygenated —> conformation change to very low affinity state —> Val gets exposed to the surface and will associate with exposed Val of other HbS molecules (hydrophobic interaction) —> if there is a substantial number of deoxygenated HbS, strands form, which then assemble to fibers —> Fiber formation leads to distortion of the RBC and the formation of sickle-shaped cells Change in hemoglobin structure: The hydrophobic valine causes hemoglobin molecules (HbS) to stick together under low oxygen conditions. Polymerization: HbS molecules polymerize (clump) inside red blood cells when oxygen is low.

Question 26

Sickle Cell Disease: Inheritance and Epidemiology

Answer 26

• The disease manifests in patients who are homozygous • Heterozygous individuals are typically healthy —The mutated beta-subunit is expressed (but not every Hb will consist of the mutated subunit only) — The mutated protein provides protection from malaria • Most common in people with ancestors from — Sub-Saharan Africa — Hispanic areas of South and Central America and the Caribbean — Saudi Arabia — India — Mediterranean countries

Question 27

Myoglobin is located in _______________________ cells. muscle white blood liver red blood

Answer 27

Muscle

Question 28

Through which of the following is oxygen attracted to heme? Hydrophobic interaction Ionic bonding Hydrogen bonding Iron2+ (Fe2+) has an electron that oxygen is attracted to

Answer 28

Iron2+ (Fe2+) has an electron that oxygen is attracted to

Question 29

The steeper a ligand binding curve, the higher the affinity for the ligand. T or F

Answer 29

T

Question 30

The mutation that causes sickle cell disease leads to a change of amino acid #6 in the beta subunit from ________________________. hydrophobic valine to hydrophilic glutamate hydrophilic glutamate to hydrophobic valine hydrophilic valine to hydrophobic glutamate hydrophobic glutamate to hydrophilic valine

Answer 30

hydrophilic glutamate to hydrophobic valine

Question 31

What is the structure of fetal hemoglobin? It consists of two alpha and two gamma subunits. It consists of two alpha, two beta , and two gamma subunits It consists of two gamma and two delta subunits. It consists of two alpha, one beta, and one gamma subunits.

Answer 31

It consists of two alpha and two gamma subunits.

Question 32

Oxygen is transferred from maternal to fetal blood because fetal hemoglobin cannot bind BPG. the pH in fetal blood is higher than in maternal blood. fetal hemoglobin does not use iron but magnesium embedded in the porphyrin ring. adult hemoglobin has a lower affinity for oxygen than fetal hemoglobin.

Answer 32

adult hemoglobin has a lower affinity for oxygen than fetal hemoglobin.

Question 33

Which of the following increases the affinity of hemoglobin for oxygen? Increasing the BPG (2,3-bisphosphoglycerate) concentration. Increase in proton ([H+]) concentration. Carbon monoxide (CO) binding. Iron deficiency.

Answer 33

Carbon monoxide (CO) binding. CO binds strongly and tightly to hemoglobin’s oxygen-binding sites, increasing overall affinity for oxygen at remaining sites, but prevents O₂ release. Carbon monoxide (CO) binding increases hemoglobin’s affinity for oxygen (but dangerously inhibits oxygen delivery).

Question 34

Individuals who have the sickle cell mutation have protection from ________________. COVID-19 malaria Lyme disease West Nile virus

Answer 34

Malaria

Question 35

Which of the following statements about hemoglobin function is correct? Adult hemoglobin's affinity for oxygen is not affected by pH changes. The higher the pH, the higher the affinity for oxygen. The higher the proton concentration ([H+]), the higher the affinity for oxygen. Any deviation from pH 7.0 leads to a lower affinity for oxygen.

Answer 35

The higher the pH, the higher the affinity for oxygen.

Question 36

Respiration: Types External Respiration Internal Respiration Cellular Respiration

Answer 36

1. External Respiration — Exchange of gases between the external environment and the alveoli of the lungs 2. Internal Respiration — Exchange of gases (as oxygen and carbon dioxide) between the cells of the body and the blood 3. Cellular Respiration — The metabolic processes by cells break down carbohydrates, amino acids, and fats to produce energy in the form of adenosine triphosphate (ATP) • WHAT IS THE BIG PICTURE? .

Question 37

Conducting Zone

Answer 37

• Passage for airflow • Nasal/Oral cavity • Pharynx/Larynx • Trachea • Bronchial tree • Terminal bronchioles *clean humidify passage for air to get to

Question 38

Respiratory zone

Answer 38

• Serve as gas exchange regions • Respiratory bronchioles • Alveolar ducts • Alveoli sacs • Alveoli **Gas exchange

Question 39

Mucous Membrane: Overview

Answer 39

Membrane that lines body cavities and passageways (canals) that are exposed to the outside of the body • Respiratory, digestive, and urogenital tracts Membrane varies in location of body, but consistently has: • One or more layers of epithelial tissue • Can be ciliated • Goblet cells • Secrete the mucous • Basement membrane • Lamina Propria • Muscularis layer Lamina Propria • Thin layer of connective tissue found under the epithelium of tissues that are exposed to the external environment • Loose connective tissue • Rich in vascular networks, lymphatic vessels, elastic fibers, and smooth muscle • Immune cells hang out within Mucous Membrane: Functions Protection • Friction • Pathogen • Help keep underlying tissues hydrated

Question 40

Conducting Zone: Pharynx Divided Into Three Regions

Answer 40

• Nasopharynx • Oropharynx • Laryngopharynx • Muscular funnel between the posterior nasal apertures to larynx • Allows for passage of gasss and food/liquids • Swallowing and speech function

Question 41

Conducting Zone: Larynx

Answer 41

Larynx Functions • Prevents food and water from entering the trachea • Sound production (voice box) Larynx Structures • Epiglottis • Blocks off trachea when swallowing food/liquid • Vestibular folds (false vocal cords) • Close to further prevent food from entering the trachea • Vocal cords • Glottis

Question 42

Conducting Zone: Trachea

Answer 42

Mucociliary Escalator Respiratory Epithelium • Ciliated pseudostratified squamous epithelium • Goblet cells

Question 43

Conducting Zone: Highlights

Answer 43

• Bronchial tree’s lamina propria has MALT: Mucosa Assisted Lymphatic Tissue • Crushes those pesky pathogens that somehow still make it down into the bronchial tree • All the way down to the bronchioles is a well-developed smooth muscle layer • Bronchioles • About 1mm in diameter • Lack the supportive cartilage • Pulmonary Lobule • Portion of the lung ventilated by one bronchiole • Each bronchiole divides into 50-80 terminal bronchioles • Less than 0.5 mm in diameter • Each terminal bronchiole gives off 1-2 respiratory bronchioles • Technically part of the respiratory zone

Question 44

All of the statements are true regarding the mucous membrane, except? • A. The epithelium layer is exposed to the external environment • B. The lamina propria can be composed of lymphatic tissue and immune cells • C. The mucous membrane role is to protect the body from pathogens • D. There is little to no mucous in this region of the respiratory system

Answer 44

D

Question 45

The conducting zone can have little amounts of gas exchange occur in this region. • A. True • B. False

Answer 45

B

Question 46

The bronchioles have smooth muscle, cartilage, and cilia. • A. True • B. False

Answer 46

B No cartilage

Question 47

Alveolar ducts connect the respiratory bronchioles to ______ ____

Answer 47

Alveolar sacs Order: Trachea—> bronchi—> bronchioles —> Respiratory bronchioles—> Alveolar ducts —> Alveolar sacs

Question 48

_______ _______ have alveoli and alveolar sacs attached to them

Answer 48

Respiratory bronchioles

Question 49

Respiratory Zone: Alveolar Cells

Answer 49

• Alveolar Cells • Squamous (Type I) Alveolar Cells • Extremely thin • Allows for gas exchange to occur • ~95% of alveolar surface • Great (Type II) Alveolar Cells • Help to repair damage to the Type I cells • Secrete SURFACTANT • Alveolar Macrophages • Roam the alveoli and alveolar sacs • Macrophages are phagocytic cells • Phagocytize debris and eventually hitch a ride on the mucociliary escalator

Question 50

Pulmonary Acinus

Answer 50

Everything distal from a terminal bronchiole The pulmonary acinus is the functional respiratory unit of the lung where gas exchange occurs. It includes all the airway structures distal to a terminal bronchiole, and it's a key structure in understanding lung anatomy, physiology, and pathology.

Question 51

Respiratory Zone: Surfactant

Answer 51

Surfactant Function • Decrease surface tension where atmospheric air interacts with water —Think of the paper analogy • Increase pulmonary compliance • Prevent atelectasis —Collapse of lung

Question 52

Lung Tissue and Pleurae: Function

Answer 52

• 1. Reduce friction • 2. Help create a pressure gradient within the lungs • The pressure in this space is normally slightly less than atmospheric pressure • Makes it a negative pressure relative to the lungs and atmosphere • Keeps the lungs “expanded” • 3. Compartmentalization

Question 53

What is the difference between Type I and Type II alveolar cells?

Answer 53

One does gas exchange; one does protection- which one does which? Type I gas exchange Type II secretes surfactant (maintain and repair type I)

Question 54

Describe the anatomy and role of the lung pleura.

Answer 54

Parietal and Visceral pleura with a pleural cavity that reduces friction, create a pressure gradient for lung expansion, and compartmentalization

Question 55

Pulmonary Ventilation: Overview

Answer 55

• Conducting zone (and tiny part of respiratory zone) contains smooth muscle • These smooth muscles change the diameter of the airways ultimately affecting the resistance or speed of airflow • DOES NOT CREATE AIRFLOW Air moves from an area of HIGH pressure to an area of LOW pressure

Question 56

There are three “areas” of pressure when examining pulmonary ventilation

Answer 56

• Atmospheric (barometric) pressure • Intrapulmonary pressure (intra-alveolar pressure) • Intrapleural pressure

Question 57

Respiratory Muscles: Overview

Answer 57

Skeletal Muscles Regulate the Intrapulmonary Volume and Pressure Increase The Volume — Decrease the intrapulmonary pressure — Expand the rib cage Decrease The Volume — Increase the intrapulmonary pressure

Question 58

Primary Respiratory Muscles (2) Accessory Respiratory Muscles (4)

Answer 58

Primary = • Diaphragm (prime mover) • Intercostal muscles Accessory = • Sternocleidomastoid (SCM) • Scalenes • Pectoralis minor • Abdominal muscles

Question 59

Pulmonary Ventilation: Regulation

Answer 59

• Pulmonary ventilation is mainly under unconscious control —Still have conscious control —What controls our breathing • Respiration Rate — Total number of respiratory cycles that occur each minute — Can be a metric indicating disease — Controlled by the respiratory centers located in the brain stem — Responds primarily to changes in carbon dioxide, oxygen, and pH levels in the blood

Question 60

Pulmonary Ventilation: Neural Control

Answer 60

Conscious Control of Pulmonary Ventilation • For signing, speaking (especially loudly) • Breath-holding • Valsalva maneuver (grunting lol) • UMN – LMN control • Limitation of conscious control • As a kid or do your kids threaten to hold their breath until they get what they want? Unconscious Control of Pulmonary Ventilation • There are three respiratory centers in the brainstem that control unconscious breathing • Pons — Pontine Respiratory Group • Medulla — Dorsal and Ventral Respiratory Groups

Question 61

Pulmonary Ventilation: Neural Control • Pontine Respiratory Group (PRG)

Answer 61

• Composed of the apneustic and pneumotaxic centers • Apneustic Center • Stimulates neurons in the DRG • Controlling the depth of inspiration (deep breathing) • Pneumotaxic Center • Inhibits the activity of neurons in the DRG • Allows relaxation after inspiration • Controls overall rate respiration rate

Question 62

Pulmonary Ventilation: Neural Control Dorsal Respiratory Group (DRG) Ventral Respiratory Group (VRG)

Answer 62

Dorsal Respiratory Group (DRG) • Maintains a constant breathing rhythm • Stimulates the diaphragm and intercostal muscles to contract, resulting in inspiration • When DRG signals cease, it no longer stimulates the diaphragm and intercostals to contract, allowing them to relax resulting in expiration Ventral Respiratory Group (VRG) • Involved with forced breathing • Stimulate accessory muscles involved in forced breathing to contract resulting in forced inspiration and expiration

Question 63

Pulmonary Ventilation: Inputs Inputs to the Respiratory Centers That Influence Rate and Depth

Answer 63

- limbic systems - ventral chemoreceptors - peripheral chemoreceptors - stretch receptors - irritant receptors

Question 64

Two Main Factors That Influence Resistance (airflow)

Answer 64

• 1. Bronchiole diameter • 2. Compliance of lungs (pulmonary compliance)

Question 65

Bronchiole Diameter

Answer 65

• Bronchodilation • Increases the diameter and increases airflow • Sympathetic NS (epinephrine and norepinephrine) • Bronchoconstriction • Decreases the diameter and decreases airflow • Parasympathetic nervous system, cold air, irritants

Question 66

Pulmonary Compliance

Answer 66

• Relates to the ability of the lungs to expand • Is it more challenging to expand? • Less expansion, less volume increase, overall loss of change in intrapulmonary pressure • Pulmonary diseases can lead to less compliant lungs • Pulmonary fibrosis • Decrease surfactant secretion

Question 67

All of the following muscles are a primary muscle of inspiration, except? 2 • A. Diaphragm • B. Sternocleidomastoid • C. Internal intercostals • D. External intercostals • E. Pectoralis minor

Answer 67

A and D

Question 68

How does intrapulmonary pressure change?

Answer 68

Respiratory muscles contract causing the lungs to expand

Question 69

What is the role of the phrenic nerve?

Answer 69

Contracts the diaphragm

Question 70

Dorsal Respiratory Group stimulates the diaphragm? • A. True • B. False

Answer 70

A Stimulates the diaphragm and intercostal muscles to contract, resulting in inspiration

Question 71

Gas pressure gradient allows for gas exchange

Answer 71

• From alveolar space —> capillary • From capillary —> alveolar space

Question 72

Boyle’s Law

Answer 72

Definition: As the volume of a gas increases, its pressure decreases—provided temperature and gas quantity stay constant • Clinical Tie-in: This inverse relationship drives air into and out of the lungs during ventilation

Question 73

Fick’s Law

Answer 73

Definition: The rate of gas diffusion across a membrane depends on surface area, pressure gradient, and gas solubility, and is inversely related to membrane thickness • Clinical Tie-in: Conditions like fibrosis or emphysema impair gas exchange by altering surface area or thickness • 1. Partial Pressures of Oxygen and Carbon Dioxide • 2. Alveolo-Capillary Membrane —Surface Area and Thickness • 3. Solubility of Gases • 4. Ventilation - Perfusion Coupling

Question 74

Dalton’s Law

Answer 74

Definition: In a mixture of gases, each gas exerts its own pressure independently, and the total pressure equals the sum of these partial pressures • Clinical Tie-in: Oxygen and carbon dioxide move based on their individual partial pressure gradients in the lungs and blood The pressure that would be exerted by one of the gases in a mixture if it occupied the same volume on its own — Dalton’s Law • Total pressure exerted by the mixture is the sum of the partial pressures of the individual gases in the mixture (Dalton’s Law)

Question 75

Henry’s Law

Answer 75

Definition: The amount of gas that dissolves in a liquid is directly proportional to its partial pressure and its solubility in that liquid • Clinical Tie-in: CO₂ dissolves more readily than O₂ in blood due to its higher solubility, aiding efficient gas exchange

Question 76

Types of Partial Pressure

Answer 76

• Partial Pressure (PA) — Partial pressure of a gas in the alveoli • Partial Pressure (Pa) — Partial pressure of a gas in the pulmonary capillary

Question 77

Gas Exchange: Alveoli- A/C Membrane

Answer 77

Gases diffuse from alveoli to pulmonary capillaries and vice versa • Where is this surface area focused? Type 1 for surface area and gas exchange • Surface Area: Direct Proportion —If surface area decreases, gas exchange decreases —If surface area increases, gas exchange increases • Membrane Thickness: Indirect Proportion — As thickness increases, gas exchange decreases — As thickness decreases, gas exchange increases

Question 78

Gas Exchange: Alveoli- Solubility of Gases

Answer 78

• Refers to a gas’s ability to dissolve in water (plasma) • Carbon dioxide is 20x more soluble than Oxygen • Despite oxygen having a larger pressure gradient difference than carbon dioxide, gas exchange is about the same —Due to carbon dioxide being more soluble

Question 79

HENRY’S LAW

Answer 79

The greater the solubility of a gas, the greater number of gas molecules that will dissolve in the liquid

Question 80

Carbon dioxide is 20x more soluble than _____

Answer 80

Oxygen

Question 81

Gas Exchange: Alveoli- V/P Coupling

Answer 81

Ventilation – Perfusion Coupling coupling is the body's way of matching airflow (ventilation) to blood flow (perfusion) in the lungs so gas exchange can occur as efficiently as possible —VENTILATION refers to the amount of air (gases) reaching the alveoli — PERFUSION refers to the amount of blood flow to the alveolar sacs • If Ventilation is Low in a Region of the Lung — Oxygen levels drop → pulmonary arterioles constrict → blood is redirected to better-ventilated areas • If Ventilation is High in a Region of the Lung — Arterioles dilate → bring more blood to where the oxygen is

Question 82

Gas Exchange: Diffusion

Answer 82

• The process of gas exchange (DIFFUSION) (V) across the alveolo-capillary membrane • Directly Proportional To: • Inversely Proportional To: • Thickness of membrane barrier (T) • Difference of Partial Pressure between alveoli and pulmonary capillary (PA / Pa) • Surface area (A) • Diffusion coefficient (D) • Solubility of gas ** PARTIAL PRESSURE GRADIENT (PA – Pa) of a gas is the driving force for diffusion • NOT concentration of that gas • Fick’s Law • A: Surface of alveoli • D: Diffusion Coefficient of gas • PA / Pa: Partial pressure of gas • T: Thickness

Question 83

Gas Exchange: Alveolar Gas Diffusion ***LOOK at Slide 141 Small CO2 diffusion

Answer 83

A partial pressure gradient is what drives gas movement. O₂ moves from high pressure (lungs) → low pressure (blood/tissues). CO₂ moves from high pressure (tissues/blood) → low pressure (lungs). O₂ needs a big gradient to diffuse well; CO₂ can diffuse efficiently even with a small gradient because it’s very soluble.

Question 84

Henry’s Law

Answer 84

• States that the amount of gas that dissolves in water is determined by its solubility into water and its partial pressure in the air —Pressure Applied: Gases can be “forced” to dissolve into a liquid (blood) —Pressured Released: Gases can dissolve out of a liquid (blood)

Question 85

But to allow gas exchange, we need:

Answer 85

• Partial Pressure Gradient • Allow gases to dissolve in and out of blood

Question 86

How does the partial pressure of a gas influence it’s diffusion?

Answer 86

Lower partial pressure of a gas decreases its diffusion rate

Question 87

How does pneumonia influence gas exchange?

Answer 87

Impairs gas exchange by alveolo-capillary membrane

Question 88

Why does oxygen need a higher partial pressure to allow for maximum diffusion?

Answer 88

It has an extremely low solubility factor

Question 89

How does ventilation influence blood perfusion within the lungs?

Answer 89

Increased ventilation stimulates increased perfusion and vice versa

Question 90

Oxygen is Transported in the Blood Through 2 Mechanisms:

Answer 90

• (1) Dissolved in plasma • (2) Bound to Hemoglobin (98%)

Question 91

Carbon Dioxide is Transported in the Blood Through 3 Mechanisms:

Answer 91

• (1) Dissolved in plasma (5%) • (2) Bound to hemoglobin (10%) • (3) As (HCO3- ) bicarbonate ion (85%)

Question 92

Gas Transport: Oxygen Oxygen is transported in the blood through 2 mechanisms:

Answer 92

• (1) Dissolved in plasma • (2) Bound to Hemoglobin (98%)

Question 93

Hemoglobin has 4 heme groups to bind O 2

Answer 93

• Carries 4 O 2 molecules • ~300 million hemoglobin molecules per RBC

Question 94

Hemoglobin forms a reversible bond with O 2

Answer 94

• Oxyhemoglobin (HbO2) • Deoxyhemoglobin (HHb)

Question 95

Carbaminohemoglobin

Answer 95

Hemoglobin can bind CO 2 too This is a form of hemoglobin bound to carbon dioxide (CO₂). It's involved in transporting CO₂ from the tissues back to the lungs.

Question 96

Gas Transport: Oxygen- Oxyhemoglobin

Answer 96

Oxyhemoglobin • All 4 heme groups have an O 2 molecule bound to it • After a Heme group binds its first O 2 molecule…..the hemoglobin molecule changes shape that increases the ability to bind the second O 2 molecule • When it binds the second O 2 molecule….it changes shape again to increase the ability to bind the third O2 molecule

Question 97

Gas Transport: Oxygen- Oxyhemoglobin • As hemoglobin starts to bind oxygen, its shape changes which causes the release of molecules attached to it:

Answer 97

• (1) Carbon Dioxide —Carbaminohemoglobin • (2) Hydrogen ions (H +) • (3) 2,3 Biphosphoglycerate (BPG) — AKA: 2,3-Diphosphoglyceric (DPG) *all these bind deoxyhemoglobin

Question 98

Gas Transport: Oxygen- Deoxyhemoglobin Molecules Bound To Deoxyhemoglobin:

Answer 98

• (1) Fractional amount of Oxygen • Maybe one heme group • (2) Carbon Dioxide bound to the globin chains of hemoglobin • Carbaminohemoglobin • (3) Hydrogen ions (H +) bound to negatively charged (-) amino acids on globin chains • Why Hydrogen ions? • (4) 2,3-Biphosphoglycerate (BPG) • AKA: 2,3-Diphosphoglyceric (DPG) • Stabilizes the structural shape of deoxyhemoglobin and promotes oxygen release FURTHER EXPLAIN AND RELATION TO pH!! Hemoglobin, Oxygen, and Shape Change As hemoglobin (Hb) binds to oxygen (O₂) in the lungs: Its shape changes from the Tense (T) state (low oxygen affinity) to the Relaxed (R) state (high oxygen affinity). This shape change causes release of: Carbon dioxide (CO₂) – released from carbaminohemoglobin Hydrogen ions (H⁺) 2,3-Bisphosphoglycerate (BPG) 🧪 So, How Does This Affect Blood pH? When Hb releases H⁺ ions, this has a direct effect on pH: In the Lungs (Oxygen-Rich Environment): Hb binds O₂ ➝ releases H⁺ ions and CO₂ These H⁺ ions are buffered (often by bicarbonate system: HCO₃⁻ + H⁺ → H₂CO₃ → CO₂ + H₂O) CO₂ is exhaled This raises the blood pH slightly (makes it more alkaline) In the Tissues (CO₂-Rich, Oxygen-Poor Environment): CO₂ diffuses into the blood and reacts: CO₂ + H₂O ⇌ H₂CO₃ ⇌ H⁺ + HCO₃⁻ This lowers pH (more acidic environment) Lower pH causes Hb to release O₂ more easily (Bohr effect) 💡 Bohr Effect – Key Concept Low pH (high H⁺/CO₂) ➝ Hemoglobin releases O₂ more easily High pH (low H⁺/CO₂) ➝ Hemoglobin holds on to O₂ more tightly This mechanism ensures that: In active tissues (acidic, high CO₂), hemoglobin releases O₂ In the lungs (more alkaline), hemoglobin picks up O₂ and releases CO₂ and H⁺ 🔁 Summary: Binding of O₂ by hemoglobin releases H⁺ and CO₂ This raises blood pH slightly in the lungs In tissues, CO₂ production lowers pH, promoting O₂ release This dynamic helps regulate blood pH and ensures efficient gas exchange

Question 99

Gas Transport: Carbon Dioxide

Answer 99

Carbon Dioxide Travels In Blood • (1) Dissolved in plasma (~10%) • (2) Bound to hemoglobin (~10%) • (3) As (HCO3- ) bicarbonate ion (~80%) ** • Majority of CO2 is transported in the blood as (HCO 3- ) bicarbonate ion

Question 100

Gas Exchange and Transport: Characters

Answer 100

Characters in Transporter V: • Oxygen • Carbon Dioxide • Carbaminohemoglobin • Hemoglobin • • Hydrogen ions (H +) • 2,3-Biphosphoglycerate (BPG) Bicarbonate Ion: HCO3- Bicarbonate ions (HCO 3-) Carbonic Acid: H2CO3

Question 101

Gas Exchange and Transport: Systemic

Answer 101

Systemic Oxygen Gas Exchange and Transport • (2%) Diffuses from the Plasma – Capillary – Interstitial Fluid – Tissues/Cells • (98%) Diffuses from Hemoglobin (heme) • Heme – RBC (membrane) – Capillary (endothelium) – Interstitial Fluid – Tissues/Cells • Hydrogen ion (H+) added to Hemoglobin after it releases O 2 Systemic Oxygen Gas Exchange and Transport • (2%) Diffuses from the Plasma • (98%) Diffuses from Hemoglobin • **Gains H+ ion Systemic Carbon Dioxide Gas Exchange and Transport • (5%) Diffuses from Tissues/Cells – directly into Plasma • (10%) Diffuses from Tissues/Cells – into RBC – binds to Hemoglobin (goblin chain) (HCO3-) **carbaminohemoglobin (85%) as Bicarbonate Ion • Diffuses from Tissues/Cells – into RBC – quickly converted into Bicarbonate ion – pumped into Plasma as Bicarbonate ion (HCO 3-) • Carbaminohemoglobin • Diffuses from Tissues/Cells – into Plasma – slowly converted into Bicarbonate ion

Question 102

Gas Exchange and Transport: Systemic Systemic Carbon Dioxide Gas Exchange and Transport

Answer 102

• (85%) as Bicarbonate Ion • Formation of bicarbonate ions in RBC are dependent upon enzyme • Carbonic Anhydrase (CAH) • Reversible reaction • FAST, VERY FAST • Note how bicarbonate ions leave the RBC into plasma • Through antiport channel • Note how hydrogen ions (H +) binds to deoxyhemoglobin • NOT SHOWN: 2,3-Biphosphoglycerate (BPG) binding to deoxyhemoglobin

Question 103

Gas Exchange and Transport: Pulmonary Pulmonary Carbon Dioxide Gas Exchange and Transport…Remember

Answer 103

• Carbon Dioxide is transported in the blood through 3 mechanisms: • (1) Dissolved in plasma (5%) • (2) Bound to hemoglobin (10%) • (3) As (HCO3- ) bicarbonate ion (85%) • Oxygen is transported in the blood through 2 mechanisms: • (1) Dissolved in plasma • (2) Bound to Hemoglobin (98%)

Question 104

Gas Exchange and Transport: Pulmonary Pulmonary Carbon Dioxide Gas Exchange and Transport

Answer 104

As RBCs approach the Pulmonary Capillaries; it is Deoxyhemoglobin: • (1) Fractional amount of Oxygen (1 heme group has O 2 bound) • (2) Carbon Dioxide bound to globin chains of hemoglobin • Carbaminohemoglobin • (3) Hydrogen ions (H +) bound to negatively charged (-) amino acids on globin chains • (4) 2,3-Biphosphoglycerate (BPG) • AKA: 2,3-Diphosphoglycerate (DPG) • Stabilizes the structural shape of deoxyhemoglobin

Question 105

Gas Exchange and Transport: Pulmonary Pulmonary Carbon Dioxide Gas Exchange and Transport

Answer 105

• (1) Dissolved in plasma (5%) • Dissolved CO2 can diffuse directly into Alveoli • (2) Bound to hemoglobin (10%) • Carbaminohemoglobin dissociates • Diffuses directly into Alveoli • (3) As (HCO 3- ) bicarbonate ion (85%) Options of converting it back to CO 2 • 1. Slow process: in plasma • 2. Fast process: moves into RBC • Note the role of the Cl - / HCO 3- Antiport • Note the role of carbonic anhydrase Pulmonary Oxygen Gas Exchange and Transport • (1) Dissolved in Plasma • Oxygen diffuses from Alveoli into the plasma (tiny amount) • (2) Bound to Hemoglobin (98%) • Oxygen diffuses from Alveoli to the Hemoglobin (heme) • Remember how the shape changes

Question 106

All of the following options can be attached to hemoglobin, except? • A. 2,3 Biphosphoglycerate • B. Carbon dioxide • C. Hydrogen ions • D. Carbonic anhydrase

Answer 106

D

Question 107

Most of carbon dioxide is transported in the plasma attached to hemoglobin. • A. True • B. False

Answer 107

B Carbon Dioxide Travels In Blood • (1) Dissolved in plasma (~10%) • (2) Bound to hemoglobin (~10%) • (3) As (HCO3- ) bicarbonate ion (~80%)

Question 108

Explain how carbon dioxide moves from tissues to lungs.

Answer 108

Note the role of carbonic anhydrase Carbonic anhydrase is a critical enzyme found mainly in red blood cells (RBCs) that speeds up the reaction between carbon dioxide (CO₂) and water (H₂O) to help transport CO₂ and maintain pH balance in the blood.

Question 109

Where do hydrogen ions that bind to hemoglobin come from?

Answer 109

Carbonic acid

Question 110

All of the options are true regarding gas transport, except? A. The Cl- / HCO3- Antiport assists with moving bicarbonate into and out of the erythrocyte. B. Bicarbonate formation occurs only in the pulmonary circuit. C. As oxygen binds to deoxyhemoglobin, hemoglobin changes its shape to increase the affinity of another oxygen molecule to bind to another heme group. D. Carbaminohemoglobin refers to when carbon dioxide binds to the globin portion of hemoglobin.

Answer 110

B Bicarbonate formation occurs mainly in the systemic circuit, not that pulmonary one. The pulmonary circuit bicarbonate is consumed to help eliminate CO2 via the lungs

Question 111

All of the statements are true regarding gas exchange, except? A. Vasodilation of the pulmonary capillaries occurs when ventilation to an area of the lungs increases. B. Carbon dioxide has a high rate of diffusion due to its partial pressure gradient difference. C. All of the options are true regarding gas exchange. D. Increasing the alveolar capillary membrane thickness leads to a decrease in oxygen diffusion into the capillaries.

Answer 111

B, b/c CO₂ does not rely on a large partial pressure gradient like O₂ does. Instead, it diffuses rapidly because: It is ~20 times more soluble in plasma than O₂. Its diffusion rate is high due to solubility, not gradient size. The partial pressure gradient for CO₂ is small (about 5–6 mmHg), but it still diffuses effectively. A -When ventilation increases, more oxygen enters the alveoli. This causes local vasodilation of pulmonary capillaries to match perfusion with ventilation.

Question 112

If airflow to a specific region of the lungs decreases, the resulting drop in oxygen levels leads to vasoconstriction of the pulmonary capillaries in that area. True False

Answer 112

T

Question 113

All of the following statements are true, except? A. The positive pressure within the pulmonary pleural assists with ventilation. B. Carbon dioxide partial pressure in the alveoli is much higher compared to the atmosphere due to residual air in the alveoli. C. Carbon dioxide has a much higher plasma solubility compared to oxygen. D. If ventilation is low in a region of the lungs, blood perfusion will decrease.

Answer 113

A

Question 114

All of the options are true regarding bronchioles, except? A. They contain cartilage. B. They contain cilia. C. They contain smooth muscle. D. All of the options are true regarding bronchioles.

Answer 114

A

Question 115

All of the statements are true regarding the respiratory zone, except? A. Cilia and cartilage are commonly found in the respiratory zone. B. The type II alveolar cells assist in the repair of the type I alveolar cells. C. Blood flow will change in response to the ventilation capabilities of alveolar sacs. D. There are macrophages within the alveoli that assist with immune protection.

Answer 115

A

Question 116

What statement is TRUE regarding respiration? The type 2 alveolar cells create the surface area for gas exchange. Gas exchange can occur anywhere in the respiratory zone. The visceral pleura lines the thoracic/rib cage. Cilia are commonly found within the conducting zone but not the respiratory zone.

Answer 116

D

Question 117

The main driving force for the decrease in partial pressure of oxygen from the atmosphere to the alveoli is due to water vapor. True False

Answer 117

T

Question 118

All of the variables are associated with Fick's law pertaining to the rate of diffusion, except? Alveolar-capillary thickness. Partial pressure of a gas. Concentration of a gas. Solubility of a gas.

Answer 118

C

Question 119

All of the following molecules could be bound to deoxyhemoglobin, except? Carbonic Anhydrase. Carbon dioxide. Oxygen molecule. 2,3 2,3-bisphosphoglycerate (BPG). Hydrogen ion.

Answer 119

A

Question 120

Surfactant's role in respiration is: Increase the compliance of lung tissue. Allow for repair of the type 1 alveolar cells. Decrease the friction in the pleura. Increase the surface area of lung tissue.

Answer 120

A

Question 121

The internal intercostal muscles are associated with the inspiration process. True False

Answer 121

F Inspiration (inhaling) - External intercostal muscles - Diaphragm - (During forced inhalation: sternocleidomastoid, scalenes) Expiration (exhaling) - Usually passive (elastic recoil) - Internal intercostal muscles (during forced exhalation) - Abdominal muscles (e.g., rectus abdominis)

Question 122

Hydrogen ions are created when carbonic acid dissociates and are ultimately secreted into the blood plasma from the red blood cell. True False

Answer 122

F Hydrogen ions (H⁺) are indeed created when carbonic acid (H₂CO₃) dissociates, but they are not secreted into the blood plasma from the red blood cell. But the H⁺ stays inside the RBC — it binds to hemoglobin (Hb).

Question 123

All of the options are classified as accessory inspiration muscles, except? Sternocleidomastoid. Pectoralis minor. Scalenes. Abdominal muscles.

Answer 123

D

Question 124

The role of carbonic anhydrase is: Ultimately convert carbon dioxide to bicarbonate ion. Stabilize the structure of deoxyhemoglobin. Assist with the binding of hydrogen ions to hemoglobin. Assist with the binding of carbon dioxide to hemoglobin

Answer 124

A

Question 125

This respiratory center directly stimulates the diaphragm muscle to contract. Dorsal respiratory group. Pneumotaxic center respiratory group. Apneustic center respiratory group. Ventral respiratory group.

Answer 125

A —-Apneustic Center • Stimulates neurons in the DRG • Controlling the depth of inspiration (deep breathing) —-Pneumotaxic Center • Inhibits the activity of neurons in the DRG • Allows relaxation after inspiration • Controls overall rate respiration rate

Question 126

What option is TRUE regarding bicarbonate ion? It assists with stabilizing deoxyhemoglobin to allow for the binding of hydrogen ions to the globin portion. It attaches to the globin portion of hemoglobin. It forms carbonic acid, which is pumped out of the erythrocyte. It is utilized to assist with maintaining blood pH.

Answer 126

D

Question 127

The majority of cells that make up the mucosa membrane in the respiratory system is: Simple squamous epithelium. Ciliated stratified columnar epithelium. Stratified squamous epithelium. Ciliated pseudostratified columnar epithelium

Answer 127

D

Question 128

All of the options are true, except? Surfactant is necessary for the recoil of the lungs. The surface area for Type I alveolar cells is vital for gas exchange. A function of the nasal cavity is to humidify the inhaled air. There is a negative pressure within the pleural cavity.

Answer 128

A

Question 129

What option is FALSE regarding restrictive lung disease? Can be due to scoliosis. All of the options are true. FEV1 / FVC ratio can be normal to on the higher end. The exhalation process takes longer. Can be due to pulmonary fibrosis.

Answer 129

The exhalation process takes longer

Question 130

Tidal volume is associated with quiet (unconscious) breathing. True False

Answer 130

T

Question 131

What volume/capacity is associated with the amount of air left in the lungs after a forceful expiration? Expiratory reserve volume. Vital capacity. Total lung capacity. Residual volume.

Answer 131

Residual volume

Question 132

All of the following options are true regarding obstructive lung disease, except? The exhalation process takes longer. FVC is normal, but FEV1 is dramatically lower. All of the options are true. The FEV1 / FVC ratio will be below normal.

Answer 132

FVC is normal, but FEV1 is dramatically lower

Question 133

Increased surface area of the type alveolar cell does what?

Answer 133

Increases gas exchange

Question 134

Increased membrane thickness in the alveolar capillary does what?

Answer 134

Decrease gas exchange

Question 135

As thickness of membrane alveoli decreases this leads to?

Answer 135

Gas change increase

Question 136

T or F The greater the solubility of a gas, the greater number of gas molecules that will dissolve in the liquid

Answer 136

True

Question 137

When O2 diffuses into the lungs the atmospheric partial pressure decreases due to what factors?

Answer 137

Water Vapor Residual air in lungs

Question 138

Formation of bicarbonate ions in RBC are dependent upon enzyme?

Answer 138

Carbonic Anhydrase (CAH)

Question 139

Bicarbonate ion plays a large role in ?

Answer 139

Maintaining blood pH levels

Question 140

As RBCs approach he pulmonary capillaries; it is _________-

Answer 140

deoxyhemoglobin • (1) Fractional amount of Oxygen (1 heme group has O 2 bound) • (2) Carbon Dioxide bound to globin chains of hemoglobin • Carbaminohemoglobin • (3) Hydrogen ions (H +) bound to negatively charged (-) amino acids on globin chains • (4) 2,3-Biphosphoglycerate (BPG) • AKA: 2,3-Diphosphoglycerate (DPG) • Stabilizes the structural shape of deoxyhemoglobin 127

Question 141

Which option best summarizes Boyle's? A. As the pressure of a gas increases, its solubility decreases. B. As the volume of a gas decreases, its pressure decreases. C. As the pressure of a gas increases, its solubility increases. D. As the volume of a gas increases, its pressure decreases

Answer 141

D

Question 142

As carbon dioxide diffuses out of cells, it can enter red blood cells. Within the red blood cells, the CO2 can combine with H2O to form carbonic acid (H2CO3). This chemical reaction is possible because red blood cells contain the enzyme: Carbonic anhydrase. Carbon dioxide acidase. Carbonic catalase. Carbonic deoxyhydrase.

Answer 142

Carbonic anhydrase

Question 143

Once formed, bicarbonate ions diffuse out of red blood cells. What process occurs to maintain electrical charge balance within the red blood cells? Sodium ions diffuse out of the red blood cell. Chloride ions diffuse into the red blood cell. Oxygen molecules diffuse into the red blood cell. Hydrogen ions diffuse into the red blood cell.

Answer 143

Chloride ions diffuse into the red blood cell.

Question 144

Which of the following is the primary method of carbon dioxide transport? Dissolved in plasma as bicarbonate ions. Bound to hemoglobin. Dissolved in plasma as a gas. Bound to albumin.

Answer 144

Dissolved in plasma as bicarbonate ions

Question 145

What formula or law refers to the partial pressure of a gas? Poiseuille's law. Boyle's law. Henry's law. Dalton's law.

Answer 145

Dalton’s law

Question 146

All of the following options could be found on deoxyhemoglobin, except? Carbon Dioxide. Oxygen. Bicarbonate ion. Hydrogen ion

Answer 146

Bicarbonate ion

Question 147

What option is accurate regarding the diaphragm during inspiration? A. Relaxes, and the dome of the diaphragm rises into the thoracic cage. B. Relaxes and moves downward toward the stomach. C. Contracts and the dome of the diaphragm rises into the thoracic cage. D. Contracts and moves downward toward the abdominal cavity.

Answer 147

D

Question 148

Regarding gas exchange in the lungs, the gas with the highest solubility coefficient is: Helium. Nitrogen. Carbon dioxide. Oxygen.

Answer 148

Carbon dioxide

Question 149

Which of the following is a statement of Henry's law? A. Pressure applied to any point in a gas is transmitted equally and undiminished to all parts of the gas and to the walls of the container. B. The partial pressure of a gas, in a mixture of gases, is the contribution it makes to the total pressure of the mixture. C. The quantity of gas that will dissolve in a liquid at a given temperature is proportional to the partial pressure of the gas and to its solubility coefficient. D. In a mixture of gases, the total pressure is the sum of the pressures exerted by each of the gases alone.

Answer 149

C

Question 150

What option is accurate regarding quiet breathing? A Inspiration and expiration involve muscular contractions. B. Inspiration is passive, and expiration involves muscular contractions. C. Inspiration involves muscular contraction,s and expiration is passive. D. Inspiration and expiration are both passive

Answer 150

C

Question 151

What term is applied to the exchange of dissolved gases between capillary blood and body tissues? External respiration. Cellular respiration. Internal respiration. Anaerobic respiration.

Answer 151

Internal respiration

Question 152

Most oxygen is carried in the blood is: A. In solution within the red blood cells. B. Combined with plasma proteins. C. Dissolved in solution within the plasma. D. Chemically combined with the heme in red blood cells.

Answer 152

D

Question 153

A 30-year-old female participates in a marathon. Which muscle(s) are being used for active expiration during the marathon? Rectus abdominus & external oblique. Latissimus dorsi. The scalenes and sternocleidomastoid. Pectoralis minor.

Answer 153

Rectus abdominus and external oblique

Question 154

Which of the following conditions would NOT produce a right shift in the oxyhemoglobin curve? A. Acclimatization to high altitude. B. Decreased body temperature. C. Vigorous exercise. D. Metabolic acidosis (decrease in blood pH).

Answer 154

B a. Acclimatization to high altitude ✅ Right shift → due to increased 2,3-BPG(2,3-BPG is made by red blood cells. It binds to hemoglobin and reduces its affinity for oxygen. This causes a right shift in the oxyhemoglobin dissociation curve. Result: Hemoglobin releases O₂ more easily to tissues that need it.) C. Vigorous exercise ✅ Right shift → ↑ CO₂, ↑ temperature, ↓ pH D. Metabolic acidosis ✅ Right shift → ↓ blood pH (Bohr effect)

Question 155

What ensures that the lungs expand as the chest wall expands? A. The elastic recoil of the alveolar tissue. B. Contraction of the internal intercostals. C. Negative pressure in the plural cavity. D. Atmospheric pressure

Answer 155

C

Question 156

Which of the following is an accessory muscle of inspiration? Anterior deltoid. Rectus abdominis. Diaphragm. Sternocleidomastoid and scalenes.

Answer 156

SCM and scalenes

Question 157

All of the options are true regarding surfactant, except? A. Helps to increase pulmonary compliance. B. Decreases surface tension in the alveoli. C. Secreted by alveolar macrophages. D. Prevents the lung tissue from collapsing.

Answer 157

C

Question 158

The process of bronchiole constriction and bronchiole dilation sets up the pressure gradients for air to flow in and out of the lungs. True False

Answer 158

False

Question 159

What statement is true? A. The conducting and respiratory zones allow for gas exchange. B. The bronchioles are the primary location of the conducting zone that can undergo bronchoconstriction and bronchodilation. C. The conducting and respiratory zones have supportive cartilage structures. D. None of the options is true

Answer 159

B

Question 160

What statement is true? The primary bronchi are the primary location where bronchoconstriction and bronchodilation occur. None of the answers is true. All of the conducting zone has supportive cartilage to assist with structural support. All the respiratory zone structures have smooth muscle.

Answer 160

None of a the answer is true

Question 161

What would be the most likely outcome if the type I alveolar cells were dysfunctional? A. The lungs would collapse. B. Gas exchange would be impacted. C. The alveoli would not be able to expand and ventilate. D. All of the options are likely to happen.

Answer 161

B

Question 162

All of the options are true regarding the respiratory system, except? A. Type II alveolar cells secrete surfactant. B. The majority of carbon dioxide is transported in the blood through diffusion into the plasma. C. A function of the nasal cavity is to humidify the incoming air. D. The majority of oxygen is transported in the blood via hemoglobin.

Answer 162

B

Question 163

All of the statements are true regarding the trachea, except? A. Trachea is posterior to the esophagus. B. Tracheal cartilage rings provide structural support. C. The mucociliary escalator is lined with goblet cells and ciliated pseudostratified squamous epithelial tissue. D. A main function is to assist with the cleansing of the inhaled air.

Answer 163

A

Question 164

Most of the change in resistance of airflow in the lungs comes from changes in the primary bronchi diameter. True False

Answer 164

F

Question 165

Sympathetic innervation of the respiratory system causes bronchoconstriction and decreased secretion from respiratory glands. True False

Answer 165

F

Question 166

All of the statements are true regarding the mucociliary escalator, except? A. Push the mucus back toward the throat. B. Is dependent upon columnar epithelial cells that have cilia. C. Helps to clear out various debris and particles within inhaled air. D. It is found primarily throughout the entire conducting and respiratory zone.

Answer 166

D

Question 167

What statement is accurate? A. Most of the mucous membrane in the respiratory system is stratified epithelium. B. The mucous membrane found within the respiratory system assists with the immune system function. C. The lamina propria function is to assist with filtering the inhaled air. D. None of the answers is accurate

Answer 167

B

Question 168

What statement is true? A. The terminal bronchioles can have gas exchange occur within them. B. None of the options is true. C. The epiglottis and vocal cords assist in blocking the passage of food and liquids into the trachea. D. A function of the respiratory system is to assist in maintaining the blood's pH levels.

Answer 168

D

Question 169

What statement is true? A. Bronchioles have smooth muscle but no cartilage within their structure. B. Increased atrial natriuretic peptide (ANP) secretion leads to increased blood pressure. C. The epiglottis is part of the pharynx. D. The mucociliary escalator is only found in the trachea and helps to warm the inhaled air.

Answer 169

A

Question 170

All of the statements regarding gas exchange and transport are true, except? A. Bicarbonate ion is produced in the erythrocyte and sent into the plasma for transport to the lungs. B. Carbon dioxide has a much higher solubility factor compared to oxygen. C. Carbonic anhydrase is necessary for oxygen transport. D. Diffusion of gases decreases with increased alveolar-capillary thickness.

Answer 170

C

Question 171

URS Pathology: Sinusitis

Answer 171

Inflammation of the sinuses Drainage of sinuses • Occurs when drainage is blocked There are several types of sinusitis, including: • Acute - Lasts up to 4 weeks • Chronic - Lasts more than 12 weeks - Can continue for months • Recurrent - Several attacks within a year Signs/Symptoms • Facial pain/pressure • Headache • Nasal congestion/Stuffy nose • Reduced sense of smell/taste • Toothache Treatment • Antibiotics (bacterial infection) • Decongestant medications • Nasal irrigation (Neti pot) • Saline rinse • Humidifier

Question 172

URS Pathology: Rhinitis

Answer 172

Inflammation and swelling of the nasal mucosa • Mucosa Caused by the common cold (virus) and allergies (hay fever) Signs and Symptoms • Stuffy nose • Runny nose • Postnasal drip • Congestion Treatment • Rest • Decongestion medications • Nasal sprays • Careful of rebound congestion

Question 173

URS Pathology: Tonsilitis

Answer 173

Inflammation of the tonsils • Tonsils • Commonly caused by a viral infection Signs and Symptoms • Sore throat • Difficulty swallowing • White/yellow patches on tonsils Treatment • Palliative treatment

Question 174

URS Pathology: Epiglottitis

Answer 174

• Inflammation of epiglottis commonly due to a bacterial infection • Epiglottis • Swelling may block airway Symptoms • Severe sore throat • Difficulty and pain with swallowing • Trouble speaking Treatment • Antibiotic • Breathing tube

Question 175

URS Pathology: Pharyngitis

Answer 175

AKA: sore throat • Inflammation of the pharynx - Pharynx • Causes pain and discomfort within the pharynx - Commonly viral • Strep Throat -Group A streptococcus bacteria -Spread by person-to-person contact with fluids from the nose or saliva Symptoms • Sore throat • Painful swallowing

Question 176

URS Pathology: Laryngitis

Answer 176

• Inflammation of the larynx - Larynx • Commonly caused by a viral infection • Causes and hoarseness and even loss of voice • Acute lasts 3 weeks or less while chronic lasts over 3 weeks - Can be caused by GERD • Treatment - Rest - Limit speaking

Question 177

URS Pathology: Laryngotracheobronchitis

Answer 177

• AKA: Croup • Acute viral infection of the larynx, trachea, and epiglottis - Areas affected • Almost exclusively in young children - From infants 6 months old to 3 years old Diagnosis • Xray • Visual exam Treatment • Palliative care Signs and Symptoms • Seal cough • Pain in swallowing • Decreased feeding • Dyspnea

Question 178

All of the conditions are commonly caused by a viral infection, except? • A. Laryngitis • B. Epiglottitis • C. Rhinitis • D. Pharyngitis

Answer 178

B

Question 179

This condition can lead to a toothache? • A. Sinusitis • B. Laryngotracheobronchitis • C. Rhinitis • D. Pharyngitis

Answer 179

A

Question 180

This condition produces a characteristic barking cough? • A. Laryngitis • B. Laryngotracheobronchitis • C. Rhinitis • D. Pharyngitis

Answer 180

B

Question 181

Diffuse Pulmonary Diseases Can Be Classified Into Two Categories

Answer 181

(1) Obstructive Disease • Characterized by limitation of airflow, usually resulting from an increase in resistance caused by partial or complete obstruction at any level • Basically, difficulty with exhaling (2) Restrictive Disease • Characterized by reduced expansion of lung parenchyma accompanied by decreased total lung capacity • Basically, difficulty with inhaling and decrease total lung volume **Use forced expiratory volume at 1 second (FEV 1) / Forced vital capacity (FVC) ratio to help differentiate between the two diseases • FEV1 / FVC ratio

Question 182

Spirometry: Measurements Forced Vital Capacity (FVC)

Answer 182

Total volume of air that can be forcibly and quickly exhaled after a maximal inspiration

Question 183

Spirometry: Measurements Forced Expiratory Volume (FEV 1)

Answer 183

Volume of air that can be forcibly expired in the first second

Question 184

Spirometry: Measurements FEV1 / FVC Ratio

Answer 184

Amount of air exhaled in one second versus the amount of air exhaled in a full breath

Question 185

FVC and FEV 1 are vital in _________ obstructive and restrictive lung diseases

Answer 185

Diagnosing

Question 186

Most spirometry machines will create two graphs relating FVC and FEV1 values:

Answer 186

1. Flow-Volume Loop • Y axis: Displays rate of airflow • X axis: Volume of air inhaled and expired • 2. Volume-Time Curve Shows volume (liters) along Y axis; time (seconds) along X axis

Question 187

Obstructive Lung Disease

Answer 187

Blockages or obstructions in the airways • Both FVC and FEV 1 are decreased, but FEV1 is dramatically decreased • FEV1 / FVC ratio is decreased —Typical of airway obstruction with its increased resistance to expiratory air flow

Question 188

Restrictive Lung Disease

Answer 188

Decrease in the total volume of air that lungs can hold • Both FVC and FEV 1 are decreased, but FEV1 is decreased but not as much as FVC • FEV1 / FVC ratio is increased

Question 189

Diffuse Pulmonary Diseases Can Be Classified Into Two Categories:

Answer 189

• (1) Obstructive Disease • Emphysema, chronic bronchitis, bronchiectasis, and asthma (airway remodelling) • COPD diseases (emphysema, chronic bronchitis) • (2) Restrictive Disease Occurs in two general conditions: 1. Extrinsic Lung Disease • Chest wall disorders in the presence of normal lungs • Severe obesity, diseases of the pleura, and neuromuscular disorders that affect the respiratory muscles 2. Intrinsic Lung Disease • Lung tissue is damaged • Pulmonary fibrosis

Question 190

Obstructive Lung Disease: Overview

Answer 190

Flow resistance in the respiratory tract is increased and ventilation of the alveoli is impaired • Shortness of breath occurs because individuals have difficulty exhaling air from their lungs • Due to the restrictions *** Will have a higher volume of air in lungs after exhalation • Commonly will have a wheezing sound when breathing • Produces a wheezing and crackling sound on auscultation

Question 191

Restrictive Lung Disease: Overview

Answer 191

• Lungs have restrictions to expand fully due to loss of compliance, elasticity, muscle weakness, or physical restriction ***Have difficulty taking a full breath

Question 192

Which condition has more of a dramatic decrease in FEV 1? • A. Obstructive lung disease • B. Restrictive lung disease

Answer 192

A

Question 193

COPD is associated with the lungs’ inability to expand fully. • A. True • B. False

Answer 193

B

Question 194

Which condition has a decrease in FVC? • A. Obstructive lung disease • B. Restrictive lung disease

Answer 194

A and B

Question 195

Obstructive Lung Disease: Overview Four Main Obstructive Lung Diseases:

Answer 195

• Emphysema • Chronic bronchitis • Asthma • Bronchiectasis

Question 196

Chronic Obstructive Pulmonary Disease (COPD) Classified:

Answer 196

• Emphysema • Chronic bronchitis **Asthma is not classified as a COPD

Question 197

Emphysema: Overview

Answer 197

Chronic respiratory condition characterized by the permanent enlargement of the alveoli distal to the terminal bronchioles • Accompanied by the destruction of alveolar walls without obvious fibrosis • Leads to reduced surface area for gas exchange, air trapping, and lung hyperinflation • Patients often present with dyspnea, a barrel-shaped chest, and use of accessory muscles for breathing - Walls of alveoli destroyed Alveoli permanently enlarge and lose elasticity • No more recoil and patient struggle with exhaling • The alveoli damage leads to bronchiole damage, collapse, and obstruction • Trapping air within the lungs • Air trapped within the lungs forms a barrel chest appearance • Leads to a normal or slightly lower FVC and a VERY LOW FEV 1 • FEV1 /FVC ratio is low

Question 198

Emphysema vs Chronic Bronchitis

Answer 198

• Emphysema is defined by structural changes • Chronic bronchitis is defined by clinical features • OFTEN CO-EXIST

Question 199

Main Factors For the Development of Emphysema

Answer 199

1. Oxidative stress • Smoking • Inhaled irritants 2. Deficiency of protease inhibitors • Several proteases are released from the inflammatory cells and epithelial cells that break down connective tissues • Deficiency of protease inhibitors (NBCE Loves This) • α1-anti-trypsin: POWERFUL protease inhibitor 3. Inflammatory cells and mediators • Induce structural changes = leads to alveolar wall destruction

Question 200

Emphysema: Pathogenesis Loss of Collagen and Elastic Fibers In Alveoli Leads To:

Answer 200

Protease mediated damage of extracellular matrix has a central role in the airway obstruction seen in emphysema • Loss of elastic tissue in the walls of alveoli that surround respiratory bronchioles causes the respiratory bronchioles to collapse during expiration • Leads to functional airflow obstruction despite the absence of mechanical obstruction. Loss of Collagen and Elastic Fibers In Alveoli Leads To: • Alveoli cannot support the bronchial tubes • Bronchi collapse and trap air within lungs • Break down of alveolar septum- causing alveoli to join together -Loss of surface area! -Less oxygen exchange = occurs in the Acinus region of the lungs

Question 201

Emphysema: Clinical Manifestations

Answer 201

Shortness of breath • Dyspnea • Cough with mucus • FEV1 /FVC ratio is low • Overtime, hypoxemia develops • Barrel chest • Pulmonary hypertension (Oh no- previous content!) • Hypoxia vasoconstriction occurs with emphysema damage Diagnosis • Imaging • Lung function tests • Bronchoscopy Treatment • Reducing risk factors- QUIT SMOKING • Medications • Bronchodilators • Steroids • Oxygen therapy

Question 202

All of the options are true regarding emphysema, except? • A. Can be caused by a deficiency of protease inhibitors (a1-anti-trypsin) • B. Bronchioles can collapse • C. Involves the alveoli permanently enlarging • D. There is significant fibrosis that occurs

Answer 202

D

Question 203

What option is TRUE regarding the clinical manifestations of emphysema? • A. Leads to dilated bronchioles • B. Damage to the bronchioles leads to damage to the alveoli • C. Individuals commonly will have chronic bronchitis with emphysema • D. All options are true

Answer 203

C

Question 204

Obstructive Lung Disease Four Main Obstructive Lung Diseases

Answer 204

Emphysema, chronic bronchitis, asthma, and bronchiectasis • Each have unique features • But also share common characteristics Chronic Obstructive Pulmonary Disease • COPD • Emphysema and chronic bronchitis

Question 205

Chronic Bronchitis: Overview

Answer 205

Chronic Bronchitis Characterized: • Persistent inflammation of the bronchi, leading to EXCESSIVE mucus production • Productive cough lasting at least three months in two consecutive years !! • The thickened bronchial walls and narrowed airways impair airflow and gas exchange, contributing to hypoxia and increased risk of infections • Clinically, patients often present with chronic productive cough, wheezing, and signs of cyanosis in more advanced stages

Question 206

Chronic Bronchitis: Pathogenesis

Answer 206

Irritants and chemicals from smoke cause hypertrophy and hyperplasia of bronchial mucinous glands and goblet cells • Hypertrophy and hyperplasia • Basically- you get mucous gland hyperplasia, goblet cell metaplasia, and infiltration of inflammatory cells • And damage the cilia too • Too much mucus and damaged cilia

Question 207

Chronic Bronchitis: Clinical Manifestations

Answer 207

Productive chronic cough • Hypercapnia * Increased carbon dioxide in blood due to increase partial pressure of CO2 in lungs • Auscultation - wheezing and crackles • Hypoxemia - Hypertrophy of muscular secreting cells - Cyanosis Due to decrease oxygen levels Skin can take on a bluish hue/tint - Pulmonary Hypertension • Hypoxia vasoconstriction occurs due to decrease oxygen flow to alveoli • Mucus obstructions - Recureent Lung Infections - Diagnosis Imaging Lung function tests Bronchoscopy - Treatment Reducing risk factors Medications (brochodilatorys, steroids, antibiotics) Break up mucus in airways

Question 208

All of the options are true regarding chronic bronchitis, except? • A. Recurrent lung infections are common • B. Smoke causes atrophy of the mucous glands and goblet cells in the bronchi • C. Has to have a productive cough for 3 consecutive months in at least 2 consecutive years • D. Causes hypoxia

Answer 208

B

Question 209

What is TRUE regarding chronic bronchitis? • A. Bronchodilators and antibiotics are commonly treatment options • B. Overall, there is too much mucus within the airways • C. Leads to hypercapnia • D. All of the above are true

Answer 209

D

Question 210

Asthma is characterized by

Answer 210

• Reversible bronchoconstriction • Airway hyperresponsiveness • Episodic symptoms of wheezing, coughing, chest tightness, and shortness of breath • Involves inflammation, mucus hypersecretion, and smooth muscle hypertrophy — Often triggered by allergens, irritants, exercise, or respiratory infections • The hallmark is the reversibility of airflow obstruction — Either spontaneously or with bronchodilator therapy

Question 211

Asthma: Overview Hallmark Characteristics

Answer 211

• Intermittent and reversible airway obstruction • Chronic bronchial inflammation with eosinophils • Bronchial smooth muscle cell hypertrophy and hyperreactivity — Bronchial constriction • Increased mucus secretion

Question 212

Categories of What Can Induce Asthma

Answer 212

1. Atopic (type 1 hypersensitivity reaction) • Most common type- Allergen sensitization • Begins in childhood • Triggered by environmental antigens • Type I IgE–mediated hypersensitivity reaction • Skin test with the offending antigen results in an immediate wheal-and-flare reaction 2. Non-Atopic • Do not have evidence of allergen sensitization • Skin test results usually are negative • Can include: Respiratory infections, cold air, exercise, air pollution 3. Drug-induced • Several pharmacologic agents invoke asthma • Aspirin 4. Occupational • Stimulated by fumes, organic and chemical dusts, gases, and other chemicals • Asthma attacks usually develop after repeated exposure to the inciting antigen(s)

Question 213

Atopic Asthma: Pathogenesis

Answer 213

• Genetic / Environment factors trigger a sensitivity reaction to an allergen • First Exposure • Allergen exposure develop sensitized IgE mast cells • Line the airways • Second Exposure • Early Phase Reaction (0-2 hours) • Late Phase Reaction (3-24 hours) • These reactions lead to the symptoms and complications of asthma

Question 214

Atopic Asthma: Pathogenesis- Early Phase Reaction Causes These Physiological Responses:

Answer 214

Within Minutes of Exposure Mast Cells Release: • Histamine • Interleukin (IL-4/5) • Other chemical mediators Physiological responses: • Increased Vascular Permeability - EDEMA • Increase Goblet Cell Secretion - Increase MUCUS PRODUCTION • Bronchial Smooth Muscle Contraction - Bronchoconstriction

Question 215

Atopic Asthma: Pathogenesis- Late Phase Reaction

Answer 215

• Inflammatory mediators stimulate epithelial cells to produce chemokines - Stimulates migration of WBCs: Eosinophils, T H2 • Eosinophils Migrate to The Area - Causes BRONCHIOLE CONSTRICTION • CAUSES AIRWAY RESTRICTION • Both Acute and Late Phase Reactions cause INFLAMMATION • Repeated bouts of inflammation lead to AIRWAY REMODELING • Kicks in 4–12 hours later and can last for hours or even days • Characterized by infiltration of inflammatory cells • Eosinophils, T2 helper cells, Neutrophils

Question 216

Late Phase Reaction Leads To:

Answer 216

• Sustained airway inflammation • Hyperresponsiveness of immune system • Epithelial damage • Thickening of the basement membrane

Question 217

Atopic Asthma: Phase Review

Answer 217

• Early Phase — Muscle + Mucus — More mucus from existing goblet cells • Late Phase • Cells + Cytokines — Get more inflammation damage and changes * CHRONIC BOUTS OF ASTHMA • Leads to Airway Remodeling! = Asthma: Airway Remodeling 1. Goblet Cell Hyperplasia • More goblet cells = more mucus = more blockage 2. Subepithelial Fibrosis • Collagen deposition thickens the basement membrane 3. Smooth Muscle Hypertrophy and Hyperplasia • More muscle = stronger and more prolonged bronchoconstriction 4. Angiogenesis • Contributes to edema and inflammation 5. Thickened Airway Walls • Leads to narrowed lumens and decreased airflow • Even when inflammation is controlled

Question 218

Asthma: Clinical Manifestations and treatment

Answer 218

• Dyspnea • Wheezing • Coughing • Labor to inhale air and then cannot exhale • Hyperinflation of lungs • Sputum — Curschmann Spirals • Spiral shaped mucus plugs • Block gas exchange and medications reaching areas of the lung — Charcot-Leyden crystals • Needled shaped crystals • Formed by the breakdown of eosinophils Asthma: Treatment • Prevention of asthma attacks and manage symptoms is the key!!! • Avoid Triggers — Cleaning living space (vacuuming) — Environmental triggers (cat dander) • Medications commonly fall into 2 categories of effect — Bronchodilators — Anti-Inflammatories • Medications can also be categorized by action time — Short-acting/Quick Relief — Long-acting/Preventative • Inhalers and Nebulizers — Mechanism to propel dry medicine to lungs — Have different effects on the lungs • Short-Acting/Quick Relief Medications — Rapid, short-term relief of symptoms — Taken during an asthma attack — Commonly, inhalers and nebulizers — Albuterol • Long-acting/Preventative — Taken daily — Used to prevent asthma attacks/symptoms rather to treat asthma attacks — Inhalable corticosteroids (inhaler) — Oral corticosteroids

Question 219

All of the following are physiological responses in the early phase reaction of asthma, except? • A. Increased bronchiole dilation • B. Increased mucus production • C. Increased vascular permeability • D. Actually, all of the options are physiological responses

Answer 219

A

Question 220

What doesn’t occur with airway remodeling in asthma? • A. Thickening of the basement membrane and fibrosis formation • B. Edema • C. Hypertrophy of bronchial smooth muscle and mucous glands • D. Alveoli damage • E. All of the options occur

Answer 220

D

Question 221

Restrictive Lung Disease: Extrinsic

Answer 221

• Any dysfunction of the breathing process that decreases lung capacity —EXCEPT DIRECT ISSUES WITH LUNG TISSUE • Chest wall disorders in the presence of normal lungs • Something impedes the ability of the lungs to expand • Scoliosis • Thoracic / Rib Subluxation and/or Postural Distortion • Amyotrophic lateral sclerosis • Diaphragm dysfunction • Obesity

Question 222

Restrictive Lung Disease: Intrinsic

Answer 222

• General term that refers to a group of conditions that cause fibrosis (scarring) of the lungs • Damage to the lungs which leads to scarring • The scarring leads to the loss of lung expansion reducing total lung capacity • Irreversible damage that is commonly progressive Disorders that arise from pathology within the lung parenchyma • Alveoli, interstitial space, and airways • Reduce lung compliance and limit lung expansion • Leads to decreased total lung capacity (TLC) and a restrictive pattern on pulmonary function tests • Can be caused by various diseases, but commonly due to: — Interstitial Lung Diseases (ILDs)

Question 223

Obstructive vs Restrictive Lung Disease Diffuse Pulmonary Diseases Can Be Classified Into Two Categories:

Answer 223

Diffuse Pulmonary Diseases Can Be Classified Into Two Categories: • (1) Obstructive (Airway) Disease • Forced vital capacity (FVC) is either normal or slightly decreased • Forced expiratory volume at 1 second (FEV 1) is significantly decreased • Ratio of FEV 1 to FVC is characteristically decreased • (2) Restrictive Disease • FVC is reduced • Lung is reduced from filling to its normal volume or capacity of air • Ratio of FEV 1 to FVC is near or about normal • The ratio FEV1/FVC is between 70% and 80% in normal adults • Value less than 70% indicates airflow limitation and the possibility of COPD Diffuse Pulmonary Diseases Can Be Classified Into Two Categories: (1) Obstructive Disease • Emphysema, chronic bronchitis and asthma • (2) Restrictive Disease • Occurs in two general conditions: 1. Extrinsic Lung Disease • Chest wall disorders in the presence of normal lungs • Severe obesity, diseases of the pleura, and neuromuscular disorders that affect the respiratory muscles 2. Intrinsic Lung Disease • Lung tissue is damaged • Pulmonary fibrosis

Question 224

Interstitial Lung Disease (ILD): Overview

Answer 224

The interstitial space of the lung becomes damaged and scarred —Space around the aveoli • Leads to reduction of the lung tissue expansion and decreased oxygen exchange that cause progressive fibrosis and inflammation of lung interstitial tissue • Can be caused by a number of factors, but the concept is the same —Fibrosis (scaring) of lungs —Restricts the ability of lung tissue to expand and inhale • ILD is not a single disease, but an umbrella term for a group of disorders

Question 225

Interstitial Lung Disease (ILD): Etiology

Answer 225

• Idiopathic Pulmonary Fibrosis —No known cause of pulmonary fibrosis —MOST COMMON FOR ILD • Drug Induced — Various other drugs can cause injury, inflammation and scaring of the lungs • Hypersensitivity Pneumonitis — A hypersensitivity reaction to environmental factors that leads to inflammation within the lungs — Mold, fecal matter, dust — Forms granulomas which lead to scarring • Autoimmune Diseases —Sarcoidosis —Scleroderma (Systemic sclerosis) —Rheumatoid arthritis • Pneumoconiosis — Occupational exposure of items that lead to fibrosis — Asbestos, coal dust, inorganic dusts, silica, vapors • Radiation Therapy • Cancer radiation treatment exposure to the lungs

Question 226

Interstitial Lung Disease (ILD): Sarcoidosis

Answer 226

Systemic, immune-mediated granulomatous disease of unknown cause, characterized by the formation of non-caseating granulomas in multiple organ (NBCE Loves This) • Most commonly the lungs • Unknown cause, but believed body is reacting so some unknown substance Diagnosis • Imaging • Biopsy Treatment • Corticosteroids • Immunosuppressants Outcomes • Leads to fibrosis of the tissue • Pulmonary fibrosis • Loss of function

Question 227

All of the options could cause restrictive lung disease, except? • A. Radiation exposure to the lungs • B. Damage to the alveoli • C. Scoliosis • D. Unknown causes (idiopathic) • E. Actually, all of the options are possible causes

Answer 227

E

Question 228

All of the options are characteristics to restrictive lung disease, except? • A. Healthy lung tissue becomes fibrotic • B. Hypoxia • C. Increased lung compliance • D. Actually, all of the options are characteristic of restrictive lung disease

Answer 228

C

Question 229

Intrinsic lung disease is a result of damage to the lung tissue or the surround space of it? • A. True • B. False

Answer 229

T

Question 230

Intrinsic lung disease vs interstitial lung disease

Answer 230

*Intrinsic Lung Disease Refers broadly to diseases originating within the lung tissue itself, especially the lung parenchyma (alveoli, alveolar ducts, and respiratory bronchioles). Encompasses conditions that affect the lung’s structure or function directly (not from external causes like pleural effusion or chest wall disorders). Includes: Interstitial lung diseases (ILDs) Pneumonias Pulmonary edema (e.g., due to heart failure) Pulmonary hemorrhage syndromes Acute respiratory distress syndrome (ARDS) * Interstitial Lung Disease (ILD) A subset of intrinsic lung diseases that specifically affect the interstitium (the tissue and space around the air sacs of the lungs). Characterized by inflammation and/or fibrosis of the interstitial tissue. Can be: Idiopathic (e.g., idiopathic pulmonary fibrosis) Secondary to autoimmune diseases (e.g., rheumatoid arthritis, scleroderma) Due to environmental/occupational exposure (e.g., asbestosis, silicosis) Drug-induced

Question 231

Lung Pleura Pathology: Overview Conditions Can Be Divided Into Two Categories:

Answer 231

• 1. Due to an issue with the plural cavity — Pneumothorax, Pleural effusion, Hemothorax • 2. Due to an issue inside of the lung (not the plural cavity) — Atelectasis (Atelectasis is a medical condition in which part or all of a lung becomes collapsed or airless, leading to reduced or absent gas exchange in that portion of the lung)

Question 232

Pleural cavity: overview Negative pressure

Answer 232

Negative Pressure • Elastin within the lungs ”pulls” lung tissue in • Ribs and diaphragm ”pulls” lung tissue out • Needed for lungs to keep their shape (not collapse) and for pulmonary ventilation

Question 233

Pneumothorax: Overview and Etiology and Manifestations

Answer 233

• Seal of the pleural space is punctured —Fills with air —Something stabs the patient • Negative pressure in pleural cavity is loss —Equalizing pressure —Elastic properties of lung take over and pull the lung tissue inward • Lung collapses Pneumothorax: Etiology • Traumatic Pneumothorax —Broken rib, needled, stab wound, gun shot wound • Primary Spontaneous Pneumothorax — Occurs in absence of trauma or underlying condition — Unknown cause — Commonly occurs in tall, thin, younger males who smoke — Family history • Secondary Spontaneous Pneumothorax • Occurs due to underlying lung disease — Emphysema Pneumothorax: Manifestations Symptoms • Shortness of breath • Dyspnea • Unilateral chest pain Diagnosis • X-ray • CT scan Treatment • Traumatic — Remove the air from pleural cavity • Spontaneous — Heal on its own

Question 234

Pleural Effusion: Characteristics Transudate and Exudate Fluid Can Be

Answer 234

• Transudate (occurs due to increased hydrostatic pressure or low plasma on optic pressure; Etc, cirrhosis, nephrotic syndrome, oncotic pressure) • Low in protein • Exudate (occurs due to inflammation and increased capillary permeability; Etc. pneumonia, cancer, TB, viral infection, autoimmune) • High in protein

Question 235

Hemothorax: Characteristics

Answer 235

• Blood in the plural space caused from trauma • Pleura ruptures and blood accumulates in the pleural cavity • Symptoms — Depends on the size and blood loss — Can be asymptomatic to dyspnea and symptoms of blood loss • Diagnosis — X-ray — Retrieval of fluid to confirm blood • Treatment — Removal of blood

Question 236

Atelectasis: Overview

Answer 236

• Loss of lung volume caused by inadequate expansion of air spaces — Alveolar collapse • Lung collapses but not due to pleura cavity being affected • Clinical Causes — Airway obstruction — Loss of surfactant — Mucus plug • Basically, something affects the alveoli not the pleural space

Question 237

Pleurisy: Characteristics

Answer 237

AKA: Pleuritis • Inflammation of the pleura • Sharp, stabbing chest pain that worsens with deep breathing, coughing, or sneezing • Most commonly caused by a viral infection

Question 238

All of the statements are true, except? • A. A pneumothorax occurs when there is air added to the pleural space • B. Transudate pleural effusion can be caused by inflammatory conditions • C. Atelectasis is when there is an issue of the alveoli, not the pleural cavity • D. Actually, all of the above options are true

Answer 238

B

Question 239

All of the statements are true, except? • A. Hemothorax is when there is blood in the alveoli • B. A spontaneous pneumothorax can heal on its own • C. A broken rib can cause a pneumothorax • D. The pleural cavity should have a negative pressure

Answer 239

A

Question 240

Infection Of The 3 Lung Tissue By Pathogens

Answer 240

• Bacterial: Staphylococcus aureus, Streptococcus pneumoniae Viral: Influenza Fungal: Different regions of US have different types of common fungus; also common in immunosuppressant • Leads to inflammation in the alveoli interfering with gas exchange • Normally, we have defense mechanisms - Mucociliary escalator - Alveolar Macrophages

Question 241

Pneumonia: Overview

Answer 241

• Inflammatory condition of the lungs that affects the alveoli • Alveoli fill with exudate and fluid • Influence gas exchange • Commonly caused by bacteria but can also be from viruses and fungal infections • Streptococcus pneumoniae and Mycoplasma pneumoniae • Pneumococcal vaccines are vaccines against the bacterium Streptococcus pneumoniae

Question 242

Pneumonia Classified By How Infection Is Contracted: Pneumonia Also Classified By Where The Infection Is Located: Pneumonia: Manifestations: s/s, diagnosis, treatment, FACTS

Answer 242

Pneumonia Classified By How Infection Is Contracted • Community acquired pneumonia (CAP) • Hospital acquired pneumonia • Aspiration pneumonia • Ventilator pneumonia Pneumonia Also Classified By Where The Infection Is Located • Lobar pneumonia • Interstitial pneumonia • Bronchopneumonia Signs/Symptoms • Dyspnea and SOB • Cough with exudate septum • Chest pain • Fatigue and fever Pneumonia Diagnosis • X-ray • Auscultation • Blood test • Test septum Pneumonia Treatment • Depends on severity and infection • Antibiotics • Pain medications • Cough suppressants Pneumonia: Facts * Community-Acquired Pneumonia (CAP) • A leading cause of death in the United States and around the world • Commonly caused by Streptococcus pneumoniae * Hospital-Acquired Pneumonia (HAP) • Also known as nosocomial pneumonia • HAP typically develops 48 hours or more after admission to a hospital • Higher potential for drug-resistant bacteria • Serious and potentially life-threatening condition

Question 243

Influenza: Overview and Manifestations (s/s, treatment)

Answer 243

• Commonly known as the flu • Acute viral respiratory infection caused by influenza viruses — 4 types of influenza viruses: Types A, B, C and D • Most people recover without treatment • Easily transmitted through coughs and sneezes (respiratory • Influenza can lead to complications, especially in certain populations such as young children, elderly individuals, and those with underlying health conditions —Can result in pneumonia with progression to acute respiratory distress syndrome (ARDS) and death from respiratory failure droplets) Influenza: Manifestations • Can infect the nose, throat, and sometimes the lungs • Can be contagious prior to symptoms • Onset of symptoms: Begin suddenly • Each year there is a new influenza vaccination that is recommended Signs/Symptoms • Fever/chills • Dry cough • Sore throat • Runny or stuffy nose • Muscle or body aches • Headaches • Fatigue (tiredness) Treatment • Rest and hydration • Antiviral medications

Question 244

Tuberculosis (TB): Overview Latent vs active infections:

Answer 244

• Estimated about 2 billion worldwide are infected — Most don’t have symptoms • Infection of Mycobacterium tuberculosis *involves the lungs primarily (may affect any organ or tissue in the body *Transmitted via air droplets (gets into the lungs) —> Latent Infection: individuals are infected but does not have symptoms —> Active infection: causes symptoms and can spread through the body • Chronic infectious disease • Caused by Mycobacterium tuberculosis —Bacterial infection • Transmitted via airborne droplets • Most commonly affects the lungs, but can also involve lymph nodes, bone, kidneys, and the CNS

Question 245

What are the three stages to tuberculosis? Describe.

Answer 245

1. Primary TB (initial infection) —-> progressive primary TB • What Happens: - Inhaled TB bacilli reach the alveoli, where alveolar macrophages engulf them but often fail to kill them - Basically, initial exposure • Immune Response: - A type IV hypersensitivity immune response kicks in after about 2–4 weeks - Leads to the formation of a Ghon focus and potentially a Ghon complex - Once formed- commonly is classified as Latent TB • Symptoms: - Often asymptomatic or mild flu-like symptoms, especially in immunocompetent individuals • Outcomes: - The immune system may contain the infection → leads to latent TB. - In immunocompromised patients (young children, elderly, HIV+), it can progress directly to active TB (primary progressive TB) ** Pathways Can Occur With Initial Infection: • 1. Progressive Primary TB — Active and contagious • 2. Latent TB — Dormant, non-contagious • Commonly occurs in people with weak immune responses - Infants, elderly, HIV+ • Immune system fails to contain the bacteria - Bacilli multiply and cause active disease right away - Immune system cannot contain bacteria in a granuloma • Patient is CONTAGIOUS!!! • Symptoms Include: - Persistent cough - Fever - Night sweats - Chest pain - Hemoptysis - Dyspnea 2. Latent TB • In 90–95% of healthy individuals, the immune response is strong enough to wall off the infection into granulomas - A granuloma is like the immune system building a little quarantine zone, basically fencing off the intruder when it can’t kick it out • Person is infected with Mycobacterium tuberculosis but does not currently have active TB disease - Bacilli are dormant, contained in granulomas - Are not infectious and cannot spread TB infection to others • Type IV hypersensitivity reaction has walled off the TB bacilli into granulomas - Within these granulomas, TB bacteria become dormant- not dead, just chilling in a hostile Airbnb surrounded by caseating necrosis - Caseous necrosis - Structure is referred to as Ghon focus ***Visible on X-Ray if calcified • Ghon focus can occur in lymph nodes - Called Ghon complex and can become calcified • Latent TB infection itself does not cause symptoms or illness - There is a risk that the infection can become active (reactivate) in the future (Secondary TB) - Especially in individuals with weakened immune systems 3. Secondary TB • Reactivation of M. tuberculosis bacteria - Through reactivation of Ghon focus - Becomes an active infection • Happens later, often years after primary infection - Triggered by immunosuppression, stress, aging, etc. - Dormant bacilli "wake up" and cause new active disease • Commonly Spreads to the Upper Lobes of the lung - Forms cavities within lungs • Causes Further Spreading of TB - Eventually gets into circulatory system and infects other parts of the body - Called Miliary TB **Miliary tuberculosis is a disseminated form of TB where Mycobacterium tuberculosis spreads via the bloodstream and starts growing in multiple organs throughout the body. • Purified Protein Derivative (PPD): AKA Mantoux Test/TB Test - Inject M. tuberculosis bacteria protein into skin and look for reaction (72 hours) - If previously exposed- location will become inflamed - Doesn’t differentiate between latent and active • Treatment —Latent Infection - Antibiotic for 9 months! — Active Infection - Combination of medications - 12 months + - Medication compliance and cost! - TB resistance strains

Question 246

Tuberculosis: Testing

Answer 246

• 1. Patient History - Chronic cough (especially >3 weeks), hemoptysis, fever, night sweats, immunosuppression • 2. Physical Exam - Crackles, bronchial breath sounds, lymphadenopathy • 3. Chest X-Ray - Looking for granulomas • 4. Microbial Testing - Sputum collection • 5. Latent TB Testing - PPD skin test (Mantoux test)

Question 247

All of the following statements are true about pneumonia, except? • A. Streptococcus pneumoniae is commonly associated with Community-Acquired Pneumonia • B. Only caused by bacterial infections • C. Higher potential for drug-resistant bacteria is found with Hospital-Acquired Pneumonia • D. Actually, all of the above options are true

Answer 247

B

Question 248

What statement is true regarding influenza? • A. Only need to get a vaccination one time • B. Symptoms typically appear a week after exposure • C. Gas exchange is commonly affected • D. Certain populations are at more risk for complications and even death

Answer 248

D

Question 249

All of the options are true regarding tuberculosis, except? • A. Treatment usually is only about 3 months long • B. Can have an active and latent phase • C. Primary tuberculosis is commonly asymptomatic • D. Ghon focus is the granuloma that forms around the bacteria

Answer 249

A 9-12 months to a year and a half

Question 250

Lung Cancer: Overview Two types of lung cancer? Three main types of NSCLC?

Answer 250

• Leading cause of cancer deaths worldwide - More people in the United States die from lung cancer than any other type of cancer • Lung cancers typically start in the cells lining the bronchi and parts of the bronchioles or alveoli • Cigarette smoking is the number one cause of lung cancer - Breathing secondhand smoke, exposed to asbestos or radon, having certain gene mutations or having a family history of lung cancer Two Main Types of Lung Cancer 1. Small Cell Lung Cancer (SCLC) —Less common but more aggressive form — About 10% to 15% of all lung cancers — Tends to grow and spread faster than NSCLC — Most people diagnosed with SCLC- the cancer has already spread beyond the lungs 2. Non-Small Cell Lung Cancer (NSCLC) About 80% to 85% of lung cancers **Three Main Types of NSCLC 1. Adenocarcinoma • Most common subtype and often occurs in the outer regions of the lungs • More common in non-smokers and tends to grow more slowly than other types 2. Squamous Cell Carcinoma • Develops in the lining of the bronchial tubes • Associated with a history of smoking 3. Large Cell Carcinoma • Less common subtype and can appear in any part of the lung • Grows and spread quickly

Question 251

Lung Cancer: Overview Risk factors, S/S, diagnosis, treatment

Answer 251

Risk Factors • Tobacco Smoke • Secondhand Smoke • Exposure to Radon • Asbestos • Radiation • Particulate inhalation Signs/Symptoms • A cough that does not go away or gets worse • Coughing up blood or rust-colored sputum • Chest pain that is often worse with deep breathing, coughing, or laughing • Hoarseness • Loss of appetite • Unexplained weight loss • Shortness of breath • Feeling tired or weak • Chronic bronchitis and pneumonia • New onset of wheezing Diagnosis • X-ray • MRI • CT • PET • Bronchoscopy • Biopsy Treatment • Chemotherapy • Radiation • Pneumonectomy

Question 252

Lung Cancer: Pancoast Tumors (NBCE Loves This)

Answer 252

• Specific type of lung cancer that occurs in the apex of the lung — Often extend into the surrounding structures, such as the ribs, vertebrae, and nerves in the brachial plexus • Can compress or invade sympathetic nerves in the thoracic region — Can lead to the classic triad of Horner syndrome symptoms • Horner syndrome is a set of signs and symptoms that occur when there is disruption or damage to the sympathetic nerve pathway • Classic features of Horner syndrome include: (NBCE Loves This) — Ptosis —Miosis (constricted pupil) —Anhidrosis on one side of the face

Question 253

Lung Cancer: Mesothelioma (NBCE Loves This)

Answer 253

• Rare and aggressive type of cancer that primarily affects the mesothelium — Thin layer of tissue that covers most internal organs • Most common site for mesothelioma is the pleura of the lungs • Primary cause of mesothelioma is exposure to asbestos — Group of naturally occurring minerals made up of microscopic fiber — Was widely used in industries such as construction (found in older homes), shipbuilding, and manufacturing before its health risks were recognized

Question 254

Other Lung Disorders: Pneumoconiosis Including most common types:

Answer 254

• General term that refers to a group of lung diseases caused by the inhalation of organic or nonorganic airborne dust and fibers over an extended period • Particles, when inhaled and deposited in the lungs, can lead to inflammation, scarring (fibrosis), and other respiratory problems- even cancer • Main cause of the pneumoconiosis is work-place exposure Most Common Types of Pneumoconiosis • Coal Worker's Pneumoconiosis (CWP) —Caused by the inhalation of coal dust • Silicosis (Silica) — Caused by inhaling crystalline silica dust, often present in occupations such as mining, quarrying, or sandblasting • Asbestosis (Asbestos) — Inhalation of asbestos fibers • Byssinosis — Also known as brown lung disease — Caused by the inhalation of cotton dust

Question 255

Pulmonary Embolism: Overview

Answer 255

Pulmonary artery blockage (caused by DVT) Risk factors for DVT… stagnation of BF Diagnosis - imaging -blood work S/s - depends on the size - small emboli may cause no sympatoms - larger emboli will cause (sudden and severe chest pain, SOB, heart palpitation/irregular beat, cough with blood) Treatment - anticoagulants - clot dissolvers -surgical removal

Question 256

All of the options are true regarding lung cancer, except? • A. Small cell lung cancers are rarer but more aggressive • B. Radon exposure is a risk factor for lung cancer • C. Pancoast tumors are found in the inferior tip of lungs • D. Mesothelioma primary cause is exposure to asbestos

Answer 256

C

Question 257

Which statement is true? • A. Pneumoconiosis is caused by inhalation of secondhand smoke • B. Pancoast tumors can lead to Horner syndrome • C. Pneumonectomy is a treatment for lung cancer and Pneumoconiosis • D. Silica inhalation is a risk factor for lung cancer

Answer 257

B D would be true is silica inhalation happened over a long period of time

Question 258

All of the options are true regarding pulmonary embolisms, except? • A. DVT is a risk factor • B. Can lead to sudden and severe chest pain • C. Stagnation of blood flow in arterial blood flow is a risk factor • D. tPA is a treatment option

Answer 258

C Because it should be stagnation of vein blood flow not arterial BF

Question 259

This disease could possibly cause obstruction of breathing and lead to a breathing tube as a treatment. Bronchiectasis. Emphysema. Epiglottitis. None of the options.

Answer 259

Epiglottitis

Question 260

This disease has than higher-than-average FEV1 / FVC ratio: Tuberculosis. None of the above. Chronic bronchitis. Pulmonary fibrosis.

Answer 260

Pulmonary fibrosis

Question 261

All of the options are true regarding tuberculosis, except? Can form cavities within the lungs. Most individuals infected are asymptomatic. Can be cured by a 2-month treatment of antibiotics. Can infect the lungs and other organs of the body.

Answer 261

Can be cured by a 2- months treatment of antibiotics

Question 262

This condition presents with children having a seal barking cough. Laryngotracheobronchitis. Pharyngitis. Tonsilitis. Laryngitis.

Answer 262

Laryngotracheobronchitis

Question 263

What condition would commonly be treated with corticosteroids? Asthma. Emphysema. Restrictive lung disease. Sinusitis.

Answer 263

Asthma

Question 264

A pulmonary embolism will have sudden and severe chest pain along with shortness of breath. True False

Answer 264

T

Question 265

All of the options are true regarding sinusitis, except? Presents with facial pain. Blurred vision is a possible symptom. A toothache could be a possible symptom Antibiotics are a possible treatment.

Answer 265

Blurred vision is a possible symptom

Question 266

All of the following statements are true regarding tuberculosis, except? The patient is contagious in the primary TB stage. Miliary TB is when the bacteria leave the lungs and spread to other areas of the body. Only in a small percentage of patients does latent TB occur. When caseous necrosis occurs, it is referred to as a Ghon focus.

Answer 266

Only in a small percentage of patients does latent TB occur.

Question 267

Which disease leads to impaired gas exchange due to fluid accumulation within the alveoli? Pneumonia. Tuberculosis. Bronchiectasis. Chronic bronchitis.

Answer 267

Pneumonia

Question 268

All of the following conditions are associated with an issue with the pleural cavity, except: Pleural cavity puncture. Atelectasis. Plural effusion. Hemothorax.

Answer 268

Atelectasis Partial or complete collapse of the lung or section of the lung

Question 269

This condition leads to a loss of surface area of the alveoli and loss of gas exchange: Asthma. Emphysema Bronchiectasis. Chronic bronchitis.

Answer 269

Emphysema

Question 270

All of the following are characteristics of lung cancer, except? Mesothelioma results from exposure to asbestos. A persistent cough that does not go away is a symptom. A Pancoast tumor is commonly found in the inferior border of the lung tissue. Horner syndrome can be a result of a Pancoast tumor. The majority of lung cancers are non-small cell.

Answer 270

A Pancoast tumor is commonly found in the inferior border of the lung tissue.

Question 271

All of the options are accurate for asthma, except? Medications that thin mucus are a common part of the treatment plan. There can be hypertrophic changes to the smooth muscles within the bronchioles. Chronic asthma can lead to airway remodeling. Curschmann spirals can be found in the sputum.

Answer 271

Medications that thin mucus are a common part of the treatment plan. ***curschmann spirals & Charcot-Leyden crystals = found in the sputum ==> asthma clinical manifestations

Question 272

What condition is associated with inadequate expansion of the air spaces and alveolar collapse? Hemothorax. Atelectasis. Pulmonary embolism. Pneumothorax.

Answer 272

Atelectasis

Question 273

A hemothorax occurs when there is a puncture in the pleural cavity and fills with air. True False

Answer 273

False Hemothorax happens when blood collects in the pleural cavity, often due to chest trauma or bleeding from damaged vessels—not air. If air enters the pleural space that is called a pneumothorax.

Question 274

** look over slide 23 for FEV1 and FVC ratio curve

Question 275

How does COPD lead to right sided heart failure? Explain.

Answer 275

The body reacts to low oxygen by narrowing blood vessels in the lungs (pulmonary vasoconstriction). This is meant to divert blood to better-ventilated lung areas. BUT in COPD, most of the lungs are affected, so this leads to widespread narrowing of lung vessels. Narrowed lung vessels make it harder for blood to flow through the lungs. This increases resistance in the pulmonary arteries. The right ventricle of the heart now has to work much harder to push blood into the lungs. Over time, the right ventricle becomes thickened and enlarged (right ventricular hypertrophy). Eventually, it can’t keep up, and the muscle weakens and fails.