respiratory Flashcards
(110 cards)
0
Q
structure that extend to the end of terminal bronchioles
A
pseudostratified ciliated columnar cells, beat mucus up and out of lung
smooth muscle of the airway wall,sparese beyond this point
1
Q
structure that extend to the end of bronchi
A
cartilage
goblet cells
2
Q
layers of gas exchange
A
type1 cell
basal lamina
endothelial of capillary
3
Q
type 1 cell function
A
alveolar surface
line the alveoli
squamous;
thin for optimal gas diffusion
4
Q
type II cells
A
secret pulmonary surfactant–>decrease alveolar surface tension and prevention of alveolar collapse(atelectasis)
cuboidal and clustered other type II cells
precursors to type I cells and other type II cells
proliferate during injury
5
Q
clara cell
A
nonciliated columnar with secretory granules secrete component of srfactant degrade toxins act as reserve cell
6
Q
surfactant is made of and begin synthesis in?
A
mixture of lecithins
most important of which is dipalmitolphosphatidylcholine
synthesis begins around wk 26 of gestation, mature level not achieved until week 35
7
Q
what indicates fetal lung maturity
A
lecithin-to-sphinogomyelin ratio>2.0
<1.5 is predictive of neonatal respiratory distress
8
Q
Macrophages of lung function
A
patrol pass the pores of Kohn
defense mechanism : last defense
secrete: elastase, which is balanced by alpha1-antitrypsin
9
Q
Lung lobes
A
Left-2+lingula
right-3
10
Q
where is the major site for inhaled foreign body
A
right lung
aspirate upright-lower portion of the right inferior lob
supin-superior portion of right inferior lobe
11
Q
Lung bottom matches to which rib
A
mid clavicular line : 6 th, 8th
mid axillary line: 8th, 10th
para vertebral: 10th, 12th
12
Q
relationship of pulmonary artery and bronchus
A
Right: anterior
Left: superior
13
Q
relationship of vein and bronchus?
A
right: inferior
left: anterior
14
Q
structure perforating diaphragm at T8
A
IVC
I ate 10 eggs at 12
15
Q
structure perforating diaphragm at T10
A
esophagus, vagus
I ate 10 eggs at 12
16
Q
structure perforating diaphragm at T12
A
aorta, thoracic duct, azygos vein
I ate 10 eggs at 12
17
Q
diaphragm is innervated by?
A
C3,4,5
pain referred to shoulder(C5)
the trapezius ridge (C3,4)
18
Q
LN of lung
A
intrapulmonary LN Bronchopulmonary LN Tracheobronchial LN, carinal Tracheobrachial LN: near laryngeal nerve Bronchomediastinal LN Right Lymphatic duct(neck and head and right arm) Thoracic duct(Left)
19
Q
muscle of respiration in quiet breathing
A
inspiration-diaphragm
expiration-passice
20
Q
muscle of respiratory during excercise
A
inspiration-external internostals, scalene muscle, sternocleidomastoids
expiration-rectus abdominis, internal and external pbliques, transverse abdominis, internal intercostals
21
Q
inspriation reserve volume
IRV
A
air that can still be breathed in after normal inspiration
22
Q
Tidal volume
TV
A
air that moves into lungs with each quiet inspiration
typically 500mL
23
Q
Expiratory reserve volume
ERV
A
air that can still be breathed out after normal expiration
24
Residual volume
air in lung after maximal expiration
| cannot be measured on spirometry
25
Inspiratory capacity
| IC
IRV+TV
26
functional residual capacity
RV+E
| RV
27
vital capacity
TV+IRV+ERV
28
total lung capacity
| TLC
IRV+TV+ERV+RV
29
FEV1
forced expiratory volume 1st second
30
FVC
forced vital capacity
31
dead space found in?
apex of healthy lung is the largest
32
emptying the conduction zone
reflects to bronchiols to decrease r-->
| dynamic compression of airway
33
2 forms of Hb
T(taut) form has low affinity for O2(shifts to the right)
R(relaxed) form has high affinity for O2
Hb exhibits + cooperactivity and - allostery
34
fetal Hb
2alpha,2gamma
has lower affinity for 2,3-BPG than adult hemoglobin
because Hb(+)+BPG(-),
fetal Hb serine(0) instead of histidine(+)
as a result Hb not that +, so affinity of BPG decrease
35
methemoglobin
oxidized form of hemoglobin (ferric Fe3+) that does not bind O2 as readily but has increase affinity for cyanide
treated by methylene blue
36
cyanide poisoning
use nitrits wot oxidize Hb to metHb, which binds cyanide, allowing cytochrome oxidase to function
use thiosulfate to bind this cyanide-->thiocyanate, renal excreted
37
nitrite poisoning
oxidizing of Fe
38
carboxyhemoglobin
for of Hb bound to CO in place of O2.
cause decrease oxygen-binding capacity with a left shift in the oxygen-Hb dissociation curve
decrease oxygen unloading in tissue
39
CO poisoning happens in?
cold weather, hot aptarment-->hb Sat increase,
| but O2 content increase
40
oxygen-Hb dissociation curve of Hb
sigmoidal shape,+ cooperativity
| binding of the 2nd O2 is earlier than the 1st, and the 3rd than the 2nd
41
oxygen-Hb dissociation curve of myoglobin
monomeric and thus does not show + cooperactivity
| lack sigmoidal appearance
42
shift to the left
```
increase affinity and decrease unloading, R form
decrease CO2
decrease BPG
alkaline
decrease Temp
CO
```
43
shift to the right
```
decrease affinity, increase unloading, T protein
increase CO2
increase BPG
increase excercis
Acid
increase Temp
```
44
Bohr effect
bind CO2 and H will decrease affinity
| shift to the right
45
Haldane Effect
bind of O2 will decrease CO2 and H
| shif tot eht left
46
inspiration effect on cardio system
```
pressure of chest decrease-->
increase blood flow of lung-->
flow to LA decrease and LV decrease-->
CO decrease-->
BP decrease-->
baroreceptor, HR increase
```
47
CPAP vs PEEPP
continuous airway pressure in spontaneous breathing patients
| +pressure is applied at the end of expiratory cycle to decrease alveolar
48
perfusion limited gas
O2, CO2, N2O
gas equilibrates early along the length of the capillary
diffusion can be increase only if the blood flow increase
less difference between aleoli& blood
49
Diffusion limited gas
O2(emphpysema, fibrosis), CO
gas does not equilibrate by the time blood reaches the end of the capillary
result in a differnence between the partial pressure of alveoli and blood
50
normal pulmonary artery pressure
10-14 mmHg
| HTN in >25mmHg, excercise: >35mmHg
51
primary pulmonary HTN
due to inactivating mutation BMPR2 gene (brimary pulmonary resistant increase)
normally function to inhibit vascular smooth muscle proliferation)
poor prognosis
52
2ndary pulmonary HTN
COPD
mitral stenosis
recurrent thromboemboli
53
pulmonary vascular resistance is due to?
viscosity of blood
vessel length
vessel radius(inverse and 4th power)
54
oxygen content of blood
dissolved O2-->PaO2
Hb carried--> Hb content and Sat
(normally every g of Hb can carry 1.34g O2)
CO poisoning: PO2 normal, Sat decrease, Hb normal, total decrease
Anemia: PO2 normal, Sat normal, Hb decrease, total decrease
Polycythemia: PO2 normal, Sat normal, Hb increase, total increase
55
A-a gradient
10-15mmHg
| increase may occur in hypoxemia, shunting, V/Q dismatch, fibrosis
56
normal A-a gradient hypoxemia
high altitude
| hypoventilation
57
measurement of diffuse rate
CO is used to measure diffuse capacity
| the most efficiently diffused
58
DD of diffuse impairment and R-L shunt
give 100% O2,
diffuse impairment PaO2 will increase,
R to L shunt will have no significant change
59
VQ at the apex of lung and base
apex:VQ=3, 肺泡大，血管小，所以是dead space，血管不通
base:VQ=0.6，血管通，但血管和肺泡接触小，肺泡不入血
both ventilation and perfusion is the greatest at the base of the lung
during excercise, vasodilation-->VQ in apex near 1
60
CO2 content in the blood
Bicrabonate
Carbaminohemogobin-CO2 bound to Hb at N-terminal
dissolved CO2
61
CO2 and ventilation's relationship
PCO2 and ventilation are reversely
62
diver's disease
high pressure under water-->N2 will dissolve in blood,
if pressure decrease-->N2 bubble in blood will caisson's
rising suddenly up to water surface
63
response to high altitude
acute in ventilation increase, decrease PO2 and PCO2
chronic in ventilation increase,
increase erythropoietin-->increase HCT and Hb
increase BPG
increase mitochondria
increase renal excretion of bicarbonate
64
response to excercise
```
increase CO2 production, O2 consumption, ventilation
increase pulmonary blood flow
VQ reatio from apex to base uniform
increase Acid
no change in artery PO2 and PCO2
increase in vein PCO2
```
65
CO2 and O2 receptor
CO2-->central receptor in medulla
| O2-->peripheral-->arterial O2
66
Homan's sign
dorsiflexion of foot-->calf pain
| deep vein thrombosis
67
sudden-onset chest pain, dyspnea, tachypnea
```
pulmonary emoboli
Fat, Air, Thrombus, Bacteria, Amniotic fluid, Tumor
95% from DVT in leg,femoral vein
CT, angiogram
Resp alkalosis, increase A-a
```
68
Long bone fracturehypoxemia, neurologic abnormalities and petechial rash
fat emboli
69
apeustic breathing
prolonged inspiration alternating with a short period of expiration
from caudal pons lesion
70
biot's breathing
irregular periods of apnea alternating with periods in which several breaths of identical depth are taken seen in patients with increase intracranial pressure and with midbrain lesion
71
cheyne-stokes breathing
periodic type of breathing which has cycles of gradually increase depth and freq
followed by a gradual decrease in depth and freq between periods of apnea
from midbrain lesion/infants, or during sleep at high altitude
72
obstructive disease
increase RV
decrease FVC, FEV1-->decrease in FEV1/FVC ratio
VQ dismatch
73
restrictive disease
decrease FVC and TLC
FEV1/FVC>80%
1. poor breathing mechanics: normal A-a. poor muscle effort-polio, myasthenia gravis; poor structural: scoliosis, obesity
2. interstitial lung disease: increase A-a,
sarcoidosis, good pasture, Wegner,Langerhans cell histiocytosis
74
chronic bronchitis
a form of COPD along with emphysema
hypertrophy of mucus secreting glands in the bronchi->reid index (thickness of gland layer/total thickness of bronchial wall)>50%
productive cough for > 3 months per year for > 2 yrs
disease of small airway
75
Emphysema
enlargement of air spaces and decrease recoil resulting from destruction of alveolar walls, increase compliance, increase elastase
centriaciner-associated with smoking
panaciner-associated with alpha1-antitrypsin deficiency
76
Asthma
bronchial hyperresponsiveness causes reversible bronchoconstriction
smooth muscle hypertrophy
curschmann's spirals(shed epi forms mucus plugs)
charcot-leyden crystals (from breakdown of eosinophils in sputum
test with methacholine challenge)
77
Bronchiectasis
Chronic necrotizing infection of bronchi-->
permanently dilated airways, purulent sputum, recurrent infection, hemoptysis.
associated with bronchial obstruction, poor ciliary motility (smoking), Kartagener's syndrome, cystic fibrosis, allergic bronchopulmonary aspergillosis
78
anthracosis
associated with coal mines
| affects upper lobes
79
silicosis
associated with foundries sandblasting and mines
Macrophages respond to silica and release fibrogenic factors, leading to fibrosis. silica may disrupt phagolysosomes and impair macrophages--> increasing susceptibility to TB
increase risk of bronchogenic carcinoma
Affects upper lobes, eggshell calcification of hilar LN
80
Asbestosis
associated with shipbuilding, roofing and plumbing
Ivory white, calcified pleural plaques
not precancerous
increase incidence of bronchogenic carcinoma and mesothelioma
affects lower lobe: golden-brown fusiform rods resembling dumbbells
81
neonatal respiratory distress syndrome
lack surfactant, shunting
lecithin:sphingomyelin<1.5
complication: PDA, necrotizing colitis, intraventricular hemorrhage
therapeutic O2 can result in retinopathy of prematurity and bronchopulmonary dysplasia.
risk: maternal DM and C-section.
treat: steroid before birth, O2 and PEEP/surfactant after
82
acute respiratory distress syndrome
| ARDS
trauma, sepsis, shock, gastric aspiration, uremia, acute pancreatitis or amniotic fluid embolism
increase capillary permeability--> protein rich leakage into alveoli-->form intra-alveolar hyaline
Neut -->type II cell damage(sufactant), activation of coagulation cascade and ROS
DD: cardiogenic: increase PCWP (wedge pressure)
83
sleep apnea
repeated cessation of breathing>10s during sleep->disrupted sleep-->
daytime somnolence
1.central--no respiratory effort
2.obstructive sleep apnea--respiratory effort against airway obstruction. Obesity, loud snoring, HTN, arrhythmias and death
hypoxia-->increase EPO release--> increase erythropioesis
84
Pickwickian syndrome
pressure from fatty neck cause airway obsruction
acute respiratory acidosis
increase PaCO2, bicarbonate,
decrease pH
85
findings in pleural affusion
decrease breath sound
dull percussion
decrease fremitus
86
finding in atelectasis
| bronchial obtruction
decrease breath sound
dull percussion
decrease fremitus
toward side of lesion
87
finding spontaneous pneumothorax
decrease breath sounds
hyperresonant percussion
decrease fremitus
toward side of lesion
88
finding in tension pneumothorax
decrease breath sounds
hyperresonant
increase fremitus
away from side of lesion
89
consolidation
| lobar pneumonia, pulmonary edema
bronchial breath sounds, late inspiratory crackles
dull percussion
increase fremitus
90
pneumonic "coin" lesion on x-ray films or noncalcified nodule on CT
lung cancer
91
adenocarcinoma of lung
peripheral
most common lung cancer in nonsmoker and females
mutation in k-ras common
hypertrophic osteoarthropathy, clubbing
bronchioloalveolar subtype(grows along alveolar septa-->thickening of alveolar wall): CXR show hazy infiltrates similar to pneumonia
92
squamous cell carcinoma in lung
central
hilar mass arising from bronchus; cavitation; cigarettes (smoking); hypercalcemia (produces PTHrP)
keratin pearls and intercellular bridges
93
small cell carcinoma of lung
oat cell, salt and pepper,
central,Amplification of myc oncogenes common
undifferentiated-->very aggressive
produce ACTH, ADH, Antibody against presynaptic calcium channels(Lambert-Eaton syndrome)
inoperable, chemo
neoplasm of neuroendocrine, Kulchitsky cells-small dark blue cell
94
Large cell carcinoma of lung
```
peripheral
highly anaplastic undifferentiated tumor
poor prognosis
less responsive to chemo
remove surgically
pleomorphic giant cells
```
95
Bronchialcarcinoid tumor
excellent prognosis, metastasis rare.
symptoms usually due to mass effect occasionally carcinoid syndrome (serotonin secretion--> flushing, diarrhea, wheezing)
nests of neuroendocrine cells, chromogranin positive
96
Mesothelioma
pleural
malignancy of the pleura associated with asbestosis
result in hemorrhagic pleural effusion and pleural thickening
psammoma bodies
97
Pancoast tumor
carcinoma that occurs in apex of lung may affect cervical sympathetic
--> Horner's syndrome
Horner's syndrome--ipsilateral ptosis, miosis, anhidrosis
98
SVC syndrome
an obstruction of the SVC that impairs blood drainage from the head (facial plethora), neck (jugular venous distention), and upper extremities (edema)
malignancy and thrombosis from indwelling catheters
emergency-->intracranial pressure-->headache, dizziness, increase risk of aneurysm/rupture of cranial arteries
99
lobar pneumonia
Intra-alveolar exudate--> consolidation; may involve entire lung
100
Bronchopneumonia
Acute inflammatory infiltrates from bronchioles into adjacent alveoli
patchy distribution involving>1 lobe
101
interstitial pneumonia
diffuse patchy inflammation localized to interstitial areas at alveolar walls
distribution involving > 1 lob
generally follows a more indolent course
102
lung abscess
localized collection of pus within parenchyma
caused by: bronchial obstruction, aspiration of oropharyngeal contents
Air-fluid levels often seen on CXR
often due to S. aureus or anaerobes
103
hypersensitivity pneumonitis
mixed type III/IV hypersensitivity reaction
dyspnea, cough, chest tightness, headache
often seen in farmers and those exposed to birds
104
transudate and exudate pleural effusion
transu: decrease protein content(0.5, LDH<0.6), CHF, nephrotic syndrome, cirrhosis
exu: increase protein, cloudy, malignancy,pneumonia (most drain)
105
lymphatic effusion
also known as chylothorax due to thoracic duct injury
milky-appearing fluid
increase TG
106
Spontaneous pneumothorax
1. accumulation of air in the pleural space
2. occurs in tall, thin, young males because of rupture of apical blebs
3. Sudden pleuritic pain, trachea deviates toward affected lung, diaphragm elevated
4. Marfan, central venous line
107
Tension pneumothorax
1. usually occurs in setting of trauma or lung infection
2. Air is capable of entering pleural space but not exiting
3. Trachea deviates away from affected lung, diaphragm depressed, compromise blood flow to heart
108
hemothorax
pain control
chest tube to drain, inder water seal
1 tube: 350-1500
2 tube:>1500
109
diffusion
V=A/T*D(P1-P2)
A=area, decrease in emphysema
T=thickness, increase in pulmonary fibrosis
D(P1-P2)=difference in partial pressure
