Pulmonary Flashcards
(127 cards)
1
Q
goblet cells
A
secrete mucous
prostaglandins
heparin (anticoagulant)
histamine
2
Q
cilia
A
pushes mucous towards pharynx
3
Q
cystic fibrosis
A
water layer gets too thick
4
Q
bronchiectasis
A
remodeling and thickening of the walls of the large airways
caused by recurrent infxn
5
Q
what are some causes of bronchiectasis
A
cystic fibrosis AIDS tuberculosis chronic bronchitis primary ciliary dyskinesia
6
Q
type I cells alveoli
A
for gas exchange
7
Q
type II cells alveloi
A
sufactant cells
8
Q
what are the two main factors contributing to inward force of the alveoli
A
elastic recoil
surface tension of water
9
Q
what usually causes respiratory distress syndrome in neonates
A
lack of surfactant
10
Q
what are a few things that can cause atelectasis
A
pressure on outside of lungs (fluid build up)
mucus plug blocking airway
lack of surfactant
anesthesia
11
Q
what is the distance between alveoli and capillary (healthy pt)
A
0.1-1.5 micrometers
12
Q
how does air move in and out
A
pressure gradient
13
Q
why does the lung move with the thoracic wall?
A
fluid is the cohesive force and keeps the two pleural membranes together
14
Q
is the pressure positive or negative in the intrapleural space? why?
A
negative
lungs pull in, chest pulls out, lymphatic system draining fluid
15
Q
what happens to alveolar pressure during inspiration and expiration
A
inspiration decreases then back to base
expiration increases then back to base
16
Q
what happens to intrapleural pressure during inspiration and expiration
A
inspiration gets more negative
expiration goes back to base (still negative)
17
Q
what are the two types of work during breathing
A
compliance work
airway resistance work
18
Q
what is flow proportional to?
A
change in pressure/ resistance
19
Q
emphysema causes
A
smoking
alpha 1 antitrypsin (protease inhibitor) deficiency
20
Q
emphysema DLCO increased or reduced
A
DLCO reduced
21
Q
pulmonary fibrosis
A
thickened alveolar membrane
stiff lung
caused by increased production of fibroblasts and collagen
22
Q
pulm fibrosis DLCO increased or reduced
A
reduced
23
Q
airway resistance
A
determined by length of tubing, viscosity, and radius
Poiseuille’s Law
24
Q
determining factors for the radius of the respiratory tubes (4)
A
mechanical connections (connective tissue, alveoli) physical (mucous) neural control (ANS) paracrine and endocrine (CO2, histamine, prostaglandins, WBC)
25
pulmonary function test
help determine obstructive vs restrictive disorder
| measures FEV1/FVC
26
bronchitis
inflammation, mucus, infxn, air trapping
27
asthma mechanism
foreign substance
release of IgE
mast cell degrannulation
muscle contraction, mucus
28
if the FEV1/FVC > 75% but FVC <75% obstructive or restrictive
restrictive
29
FEV1/FVC <75%
obstructive
30
FEV1/FVC > 75% and Normal FVC
normal healthy pt
31
why in a spirometer chart is the exhale peak fast then slow down slope?
bc as lung volume decreases the airflow out decreases bc bronchioles collapsed easily by chest pressure
32
closing volume
volume of gas in the lungs in excess of the RV at the time when small airways close
33
closing capacity
closing volume + RV
34
what increases closing capacity
age
| smoking
35
FRC decreases
laying down
anesthesia
obesity
36
FRC < Closing Capacity
closing of some airways occurs during TV breathing
V/Q mismatch
alveoli not being V
37
pulmonary "minute" ventilation
RR x TV
38
physiological deadspace
anatomical deadspace + alveolar deadspace
39
alveolar ventilation
```
RR x (TV - deadspace volume)
~4.2 L/min
```
40
equation for ventilation of alveoli
VA(L/min)= VCO2 (ml/min)/PACO2
41
metabolic acidosis
VA decrease
| PACO2 increase
42
metabolic alkalosis
VA increase
| PACO2 decrease
43
hypernea (exercise breathing)
?
44
normal blood volume of the lungs
450mL (9% of total blood)
45
mean BP in RV
25/ 2 mmHg
46
mean BP in pulm arteries
15mmHg
47
mean BP in pulm capillaries
7-8mmHg
48
mean BP in pulm veins
5mmHg
49
starlings hypothesis
fluid movement due to filtration across the wall of capillary is a balance of hydrostatic P and osmotic P
50
Capillary fluid movement equation
(Pc-Pi) - (Oc- Oi)
51
Pc
capillary pressure
| variable depending on pulmonary or systemic
52
Pi
variable pulmonary or systemic
53
net positive
fluid will move from capillary to interstitial space
54
net negative
fluid will move from interstitial space into capillary
55
3 problems leading to pulmonary edema (changes in starling forces)
nephrotic syndrome (oc decrease)
pulm capillary membrane damage (oc decrease oi increase)
left heart failure (pc increase)
56
what happens during normal LA pressure increase
recruit more capillaries to open to keep pressure low
57
V/Q= 1
normal
58
V/Q> 1
perfusion low
| dead space
59
V/Q< 1
ventilation low
| pulmonary shunt
60
how does the body compensate for high V/Q
bronchoconstriction
61
how does the body compensate for low V/Q
vasoconstriction
62
hydrostatic pressure
caused by weight of the blood above it in the vessels due to gravity (pressure increases as you go closer to the ground)
63
what is the V/Q ratio for the zone 1 of the lung
V/Q>1
64
how can you clinically measure the V/Q of the lungs
use xenon and capture with a gamma camera
65
partial pressure
pressure of a single gas
66
daltons law
total pressure of a mixture of gases is the sum of the pressures of the individual gases
67
henrys law
at constant temp the amount of a given gas dissolved in a given type and volume of liquid is directly proportional to the partial pressure of that gas in the equilibrium
68
do equal partial pressures mean equal concentrations of different gases?
NO
69
what is atomospheric PO2
160mmHg
70
why is the partial pressure of oxygen in the alveoli not equal to the atmospheric partial pressure of oxygen?
it is humidified and that reduces the partial pressure
| oxygen leaves alveoli constantly
71
water vapor pressure
47mmHg
72
tracheal PO2 equation
FiO2 * (Patm- PH2O)
73
PAO2 correcting for humidity and oxygen leaving equation
[FiO2 * (Patm- PH2O) - (PACO2/RQ)]
74
RQ
ratio of total CO2 production to O2 consumption (CO2/O2)
75
sugars (carb diet) RQ
1
76
lipids RQ
0.7
77
proteins RQ
0.8
78
mixed RQ
0.8
79
how do the nonalveolar lung tissues get blood flow
bronchial artery supplies
azygos vein take some to RV
pulmonary vein take some to LV (shunt)
80
thebesian veins are involved in what
anatomical shunt in heart
81
what are the factors that affect oxygenation of tissues (5)?
```
decrease alveolar PO2
diffusion of oxygen through membrane
gas transport
calc total oxygen carrying capacity CaO2
CO poisoning
```
82
how do you decrease PO2?
go higher in altitude
| asthma or other obstructive disease (air trapping)
83
ficks law of diffusion
diffusion rate is proportional to:
| (change in pressure * SA * diff. coefficient)/membrane thickness
84
examples of problems with diffusion
```
emphysema (loss of SA)
pulmonary fibrosis (thickening of membrane)
pulm edema (fluid in interstitial space)
```
85
DLO2
diffusing capacity of the lung for O2
86
what is the change in DLO2 when you increase cardiac output (Q)?
it decreases because of decreased pulmonary capillary transit time
87
```
pick which one is diffusion limited:
nitrous oxide
oxygen
carbon dioxide
carbon monoxide
```
CO
88
what is the purpose of the A-a gradient
diagnose the reason for hypoxemia
89
what is the equation for the A-a gradient?
[FiO2 *(Patm - PH2O)-(PACO2/0.8)] - PaO2
90
what is a normal A-a gradient
10mmHg
91
what are the two ways oxygen can be transported?
dissolved in plasma
| bound to Hb
92
what happens to the affinity of Hb to oxygen when the CO2 increases?
the affinity for oxygen decreases
93
equation for amount of O2 bound to Hb
total Hb * 1.34 * SO2
94
anemia
decreases Hb and thus decreases CaO2
95
hematocrit
ratio of red blood cells to plasma (normal range 40-50)
96
polycythemia
increase in RBC and hematocrit/Hb due to blood doping
97
blood doping (2)
injection of RBC
| use of EPO
98
polycythemia vera
bone marrow defect
increase in RBC
slows BF and increases clots
red coloring or blueish tint to areas
99
what does PO2 determine
amount of O2 dissolved in plasma
| oxygen saturation of Hb
100
PO2 = 60 what is SaO2?
90%
101
PO2= 40 what is SaO2
75%
102
do ionic interactions that form salt bridges in heme increase or decrease the affinity for O2?
decrease
103
bohr effect
decrease in O2 affinity of Hb in response to decrease pH due to increased CO2
104
what causes a right shift in the oxyHb curve?
acidosis
hypercarbia
hyperthermia
increase DPG
105
how does DPG decrease the affinity of oxygen to Hb
by binding the Hb and causing a conformational change
106
carrying capacity equation
(total Hb * 1.34 * SO2) + (PaO2 * 0.003)
107
carry capacity units
mLO2/dL
108
does CO poisoning shift the curve to the left or the right
left
109
what are the three ways that CO2 is carried in the blood?
dissolved in plasma (7%)
bound to Hb (23%)
bicarbonate (70%)
110
what is the role of carbonic anhydrase
H20+CO2=H2CO2
111
haldane effect
as Hb is oxygenated that promotes carbon dioxide dissociation
112
what in the brain stem controls breathing (neuronal control)
medulla generates signal
113
dorsal respiratory group DRG
normal breathing inspiration
114
ventral respiratory group VRG
inspiration and EXPIRATION (mostly ex)
115
what two neuronal signaling centers are in the pons to regulate breathing
```
pneumotaxic center (slower action pot)
apneustic center (faster action pot)
```
116
what do both the pneumotaxic and apneustic centers relay their signal to?
DRG
117
where do the vagus and glossopharyngeal nerves send afferent info to?
DRG
118
what do the central chemoreceptors detect changes in?
CO2
| and Hydrogen
119
what do the peripheral chemoreceptors detect changes in?
O2
(hydrogen and CO2)
aortic and carotid bodies
120
activation of peripheral chemoreceptors
```
low PO2 binds to protein on glomus cell
inhibits K release
increases Calcium entry
releases Ach
causes action potential on vagus or glosso nerve
```
121
T/F the body is more sensitive to changes in CO2 and pH than O2
true
122
if you are hypercapnic and hypoxic how does that effect the sensitivity of our respiratory changes?
additive and more sensitive
123
nociceptors
stimulated by particles/gases
| elicits bronchoconstriction, cough, tachypnea
124
hering breuer reflex
overinflation of the lungs
| inhibit inspiration at the DRG (inhibits phrenic nerve)
125
are the peripheral chemoreceptors located on arterial or venous blood supplies? why does this matter?
arterial blood
-b/c when exercising the PaO2 will stay high but you are using more O2, how does your body signal to increase RR?? stretch receptors in your muscles
126
can the higher brain control breathing?
yes you can change how your breathing by thinking about it
127
what are the two things in the limbic system that help control breathing?
hypothalamus
| amygdala
