Pulmonary

Question 1

Conducting airways

Answer 1

– Provide for movement of air from the external environment to the point of gas exchange.
Contains just over 20 subdivisions
– Lined with pseudostratified columnar
epithelium

Question 2

Bronchioles are

Answer 2

smallest conducting airway.
* No smooth muscle or cartilage
* Retention of ciliated cuboidal epithelium

Question 3

Terminal respiratory units are

Answer 3

– Respiratory bronchioles and alveolar ducts

Question 4

autonomic nervous system

Answer 4

parasympathetic
sympathetic

Question 5

Afferents are primarily vagal.

Answer 5

• Bronchopulmonary stretch receptors
• Irritant receptors in proximal airway
• C-fibers– Respond to mechanical and chemical stimuli

Question 6

Efferents

Answer 6

• Muscarinic bronchoconstriction-
• Pulmonary vasodilation
• Mucus gland secretion

Question 7

Sympathetic fibers at rest

Answer 7

– Bronchial smooth muscle relaxation
– Pulmonary vasoconstriction
– Inhibition of secretory gland activity

Question 8

NANC fibers

Answer 8

Functions primarily as reciprocal balance to excitatory cholinergic system

Question 9

Two main components of flow:

Answer 9

pulmonary and bronchial

Question 10

bronchial vessels

Answer 10

supply arterial blood to the bronchi to feed it and takes away deoxiginated blood

Question 11

pulmonary lymphatics

Answer 11

• Run along airway and vascular system

– Found in connective tissue spaces of pleura and peribronchovascular sheaths, interlobular septa

– Terminate in bronchioles (do not enter alveoli)

Question 12

compliance

Answer 12

ability of tissue to comply
- Intrinsic elastic property that relates a change in volume to a change in pressure

– Both compliance of chest wall and lungs contribute to pulmonary compliance.

– Chest wall does not change significantly with volume.

Question 13

elastic recoil

Answer 13

ability to return back to its original shape

Determined by the shape/structure of the thorax

Question 14

Two contributing factors to elastic recoil

Answer 14

• Tissue elasticity
• Force needed to change shape of air-liquid interface of alveoli
  – Surface tension is directly proportionate to surface forces that the lung has to overcome to expand.

Question 15

Inflation overcomes three opposing forces.

Answer 15

• Elastic recoil
  – Inertia of the respiratory system
  (insignificant)
  – Resistance to airflow

Question 16

Laminar flow–

Answer 16

Airway caliber is the principal determinant of airway resistance.

moving in 1 direction, no resistant

Question 17

Turbulent flow

Answer 17

– Driving pressure is proportionate to the flow rate.
driving pressure to keep flow

Question 18

Turbulent flow

Answer 18

– Driving pressure is proportionate to the flow rate.
driving pressure to keep flow

Question 19

flow is turbulent at the

Answer 19

top
trachea

Question 20

flow is laminar at

Answer 20

bottom
alveoli
bronchioles

Question 21

most negative pressure is at the

Answer 21

apex of the heart

Question 22

Distribution of perfusion

Answer 22

– Gravity influences distribution.
– In an upright patient there is a linear increase in flow from apex to base.

Question 23

Hypoxic pulmonary vasoconstriction– Pulmonary arterioles are sensitive to alveolar.

Answer 23

pO2

Question 24

When alveolar pO2 falls, resistance to flow

Answer 24

increases.

Question 24

When alveolar pO2 falls, resistance to flow

Answer 24

increases.

Question 25

Minute ventilation is

Answer 25

6 L/min.

Question 26

Minute ventilation is

Answer 26

6 L/min.

Question 27

Pulmonary artery blood flow is

Answer 27

5 L/min.

Question 28

Overall V/Q ratio is.

Answer 28

0.8

Question 29

is anatomical dead space.

Answer 29

2 L

Question 30

Resting alveolar ventilation is

Answer 30

4 L/min.

Question 31

If the area is too large, the A-a (atmospheric and arterial)gradient

Answer 31

increases.

Question 32

Shunt–

Answer 32

Perfusion without ventilation

Question 33

Atelectasis or consolidation

Answer 33

* Both pO2 and pCO2 fall because remaining respiratory units are over-ventilated relative to blood flow. * Shunt cannot correct low pO2 by increasing minute ventilation.

Question 34

sensory input

Answer 34

frequency, depth, timing of spontaneous breathing are modified by chemical and mechanical receptors.

Question 35

carotid bodies

Answer 35

Chemoreceptors at bifurcation of common carotid and aortic branch – As pO2 falls, carotid body fires signals to medullary center.

Question 36

Central chemoreceptors

Answer 36

– Mediate response to increased pCO2 – Dispersed throughout the brainstem – Increased ventilation rate in response to increased pCO2 is a function of chemoreceptors.

Question 37

Pulmonary stretch receptors

Answer 37

– Located in the airway smooth muscle and mucosa – Discharge in response to distention of the lung – Increased lung volume decreases respiratory rate as a result of increased expiration time (Hering-Breuer reflex).

Question 38

C-fibers near pulmonary capillary receptors are stimulated by irritants.Increases respiratory drive in

Answer 38

interstitial edema and pulmonary fibrosis

Question 39

Proprioceptors

Answer 39

– Skeletal movement transmits to respiratory centers. * Increased ventilation during exercise

Question 40

Spindle receptors

Answer 40

* In diaphragm and intercostals provide feedback on muscle work * When work is disproportionate to ventilation, dyspnea occurs

Question 41

Chronic hypercapnia

Answer 41

– Brain pH is compensated. – Central chemoreceptors less sensitive to arterial paCO2 – Carotid body drive is imperative.

Question 42

Chronic hypoxia .

Answer 42

– High altitudes, sleep apnea – Lung disease and hypercapnia can remove endogenous stimuli to breathe

Question 43

Which of the following is not true with respect to conducting airways?

Answer 43

Secretory glands increase as airway divides.

Question 44

The section of the airway that offers the least resistance to airflow is the:

Answer 44

Terminal respiratory unit.

Question 44

The section of the airway that offers the least resistance to airflow is the:

Answer 44

Terminal respiratory unit.

Question 45

Autonomic innervation is the primary determinant of smooth muscle activity in the airway. Irritant receptors in the proximal airway are an example of:

Answer 45

Vagal afferents.

Question 46

The NANC fibers serve primarily to:

Answer 46

Provide reciprocity to cholinergic excitation

Question 47

The __________________ are very sensitive to alveolar partial pressure of oxygen (pO2).

Answer 47

Pulmonary arteries.

Question 48

Elastic recoil is determined by:

Answer 48

Tissue elasticity and force needed to change alveolar air-liquid interface.

Question 49

pulomanry obstructive disease

Answer 49

asthma and COPD

Question 50

Asthma

Answer 50

an accelerated, inappropriate chronic inflammatory response occurring in response to any variety of triggers

Question 51

Local inflammatory cells are activated:

Answer 51

Primarily mast cells and eosinophils.

Question 52

Acute-acting mediators are released.

Answer 52

*cause bronchoconstriction Leukotrienes * Prostaglandins * Histamine

Question 53

Acute-acting mediators stimulate a variety of responses.

Answer 53

– Smooth muscle contraction – Mucus hypersecretion – Vasodilation – Endothelial leakage – Local edema formation

Question 54

COPD

Answer 54

A disease characterized by persistent and progressive airflow limitation that is not fully reversible normal response

Question 55

Chronic bronchitis may or may not be present in

Answer 55

COPD

Question 56

Chronic bronchitis

Answer 56

mucous hyper secretion -wet cough constantly A result of chronic airway injury and narrowing – Inflammation of the small airways – Hypertrophy of large airway mucus glands – Increased mucus production

Question 57

Chronic bronchitis, Normal ciliated pseudostratified squamous epithelium is replaced by

Answer 57

squamous metaplasia

Question 58

COPD has to do with

Answer 58

airflow limitation

Question 59

Emphysema

Answer 59

A disease of lung parenchyma – not airways - alveola lose their attachment to lunch parenchyma Loss of alveolar surface area and accompanying bed decrease gas exchange producing hypoxia and dyspnea.

Question 60

Types of Emphysema

Answer 60

Centriacinar emphysema Panacinar emphysema

Question 61

Centriacinar emphysema

Answer 61

This is the type most often associated with smoking.

Question 62

FEV1

Answer 62

how much a patient can put out in 1 sec

Question 63

FVC

Answer 63

how much a patient can put out over how every much time

Question 64

A patient with a FEV1/FVC of 70% and a normal FEV1 has

Answer 64

stage I COPD.

Question 65

FEV1 gives you the

Answer 65

stage of COPD

Question 66

restricted lung is usually

Answer 66

smaller than the normal lung

Question 67

Restrictive lung disease

Answer 67

There is a variety or collection of pulmonary diseases that result in pulmonary fibrosis, scarring of lung parenchyma and increased recoil and decreased compliance. * Restrictive lung diseases generally classified as intrinsic or extrinsic.

Question 68

Intrinsic lung diseases (can't keep volume in)

Answer 68

Asbestosis * Pneumonitis * Acute respiratory distress syndrome * Sarcoidosis * Idiopathic pulmonary fibrosis

Question 69

Idiopathic pulmonary fibrosis is one type of

Answer 69

restrictive lung disease with no identified cause.

Question 70

Extrinsic restrictive lung eases

Answer 70

Neuromuscular – Myasthenia gravis- weakness of diaphragm * Anatomical (nonmuscular) – Kyphosis- lose compliance of chest wall * Volume restricting – Obesity

Question 71

Hyperacute protective mechanisms that characterize an asthma attack include all of the following except:

Answer 71

Vasoconstriction

Question 72

The primary inflammatory mediators that characterize an asthma attack include:

Answer 72

Eosinophils.

Question 73

Which of the following obstructive pulmonary diseases is characterized by hypertrophy of the large airway mucus glands?

Answer 73

Chronic bronchitis.

Question 74

Acute-acting mediators released during an asthma attack include all of the following except:

Answer 74

Procalcitonin.

Question 75

The characteristics of chronic bronchitis include all of the following except:

Answer 75

Characterized by limited mucus production.

Question 76

The characteristics of chronic bronchitis include all of the following except:

Question 77

Which of the following is false in regards to the characteristics of emphysema?

Answer 77

Airway inflammation is a primary factor of disease.

Question 78

The most sensitive spirometric parameter to detect early airflow limitation is:

Answer 78

FEV1/FVC.

Question 79

The most sensitive spirometric parameter to detect early airflow limitation is:

Question 80

Intrinsic restrictive lung diseases include all of the following except:

Answer 80

The pathology of restrictive lung diseases shares all of the following characteristics except:

Question 81

Intrinsic restrictive lung diseases include all of the following except:

Answer 81

The pathology of restrictive lung diseases shares all of the following characteristics except:

Question 82

Intrinsic restrictive lung diseases include all of the following except:

Answer 82

Myasthenia gravis.

Question 83

Intrinsic restrictive lung diseases include all of the following except:

Answer 83

Myasthenia gravis.

Question 84

Intrinsic restrictive lung diseases include all of the following except:

Answer 84

Myasthenia gravis.

Question 84

Intrinsic restrictive lung diseases include all of the following except:

Answer 84

Myasthenia gravis.