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158 Cards in this Set

  • Front
  • Back
what type of cells line the alveoli?
type I alveolar cells
what is the thickness of the barrier to diffusion between air and blood?
0.2 microns
what is the name for the tissue between adjacent alveoli?
interalveolar septum
which are larger, type I or II alveolar cells?
type I
where do type II alveolar cells rest?
where the interalveolar septa meet
what type of cells line the alveoli?
type I alveolar cells
what is the thickness of the barrier to diffusion between air and blood?
0.2 microns
what is the name for the tissue between adjacent alveoli?
interalveolar septum
which are smaller, type I or II alveolar cells?
type II
where do type II alveolar cells rest?
where the interalveolar septa meet
t/f... type II cells can divide and differentiate to replace type I cells
true
what percentage of the alveolar area is comprised of type II alveolar cells?
3%
what structure allows ventilation to bypass a blocked alveolar duct?
interalveolar pores of Kohn
t/f... smooth muscle cells are found in the interalveolar interstitium
false, fibroblast-like cells and myofibroblasts but not smooth muscle cells are found in the interalveolar interstitium
which structures make up the pulmonary acinus?
respoiratory bronchiole, alveolar ducts, alveolar sacs, alveoli
what is asbestosis?
diffuse interstitial pulmonary fibrosis resulting from inhalation of large doses of asbestos fibres
what are the most dangerous forms of asbestos?
crocidolite and amosite
what is the least dangerous form of asbestos?
chrysolite
t/f... hilar lymphadenopathy is a feature of asbestosis
false, it is a common sign in sarcoidosis
what is the size of the most dangerous inhaled particles?
1-5 microns
what are the three ways for particles to be cleared from the airways?
nasal clearance, tracheobronchial clearance (mucociliary raft), alveolar clearance (by alveolar macrophages)
what percentage of cells in the lungs are inflammatory cells?
less than 10%
what type of cell accounts for over 90% of inflammatory cells in the lungs?
macrophages
which macrophage derived cytokines are chemotactic for neutrophils?
IL-8 and LTB4
what shifts the oxygen dissociation curve to the right?
increases in temp, H+ concentration, PCO2 and 2,3-DPG concentration in RBCs
what is the O2 saturation of Hb in normal arterial blood?
97.5%
what is the O2 saturation of Hb in mixed venous blood?
75%
t/f... CO has a greater affinity for Hb than O2
true
what catalyses the reaction between CO2 and water?
carbonic anhydrase
What is the FIO2 of room air?
0.21
what is the normal range for PaCO2?
35-45 mmHg
what is the normal range of PaO2?
90-100 mmHg
where is the vallecula?
anterior to the epiglottis
where are the palatine tonsils located?
between the palatoglossal and palatopharyngeal arches
what is the sensory supply to the nasopharynx?
V2
what is the sensory supply to the oropharynx?
IX
what is the sensory supply to the laryngopharynx?
X
which part of the pharynx receives sensory innervation from the maxillary nerve?
nasopharynx
which part of the pharynx receives sensory innervation from glossopharyngeal?
oropharynx
which part of the pharynx receives sensory innervation from vagus?
laryngopharynx
what is the parasympathetic supply to the nasopharynx?
VII
what is the parasympathetic supply to the oropharynx?
IX
what is the parasympathetic supply to the laryngopharynx?
vagus
which part of the pharynx receives parasympathetic supply via the facial nerve?
nasopharynx
which part of the pharynx receives parasympathetic innervation from the glossopharyngeal nerve?
oropharynx
which part of the pharynx receives parasympathetic supply via the vagus?
laryngopharynx
which pharyngeal muscle is innervated by IX?
stylopharyngeus
what is the parasympathetic supply to the laryngopharynx?
vagus
which part of the pharynx receives parasympathetic supply via the facial nerve?
nasopharynx
which part of the pharynx receives parasympathetic innervation from the glossopharyngeal nerve?
oropharynx
which part of the pharynx receives parasympathetic supply via the vagus?
laryngopharynx
which pharyngeal muscle is innervated by IX?
stylopharyngeus
what muscles make up the inferior constrictor?
thyropharyngeus and cricopharyngeus
which constrictor goes from the hyoid bone to the pharyngeal raphe?
middle constrictor
where is the superior constrictor?
pterygomandibular raphe to pharyngeal raphe
name the levators of the pharynx
palatopharyngeus, stylopharyngeus, salpingopharyngeus
where is the larynx?
C3-6
what is the name for the space between the vestibular folds?
rima vestibuli
what colour are the vocal folds?
white
what type of epithelium lines the larynx?
columnar and squamous
what muscle abducts the vocal cords?
posterior cricoarytenoideus
which muscle adducts the vocal cords?
lateral cricoarytenoideus
what is the sensory supply to the vocal folds?
SLX
which muscle of the larynx is innervated by SLX?
cricothyroideus
what is the action of thyroarytenoideus?
relaxes vocal cords
which laryngeal muscle is active during forced respiration?
posterior cricoarytenoideus
what determines the pitch of phonation?
length of vocal cords
in airways obstruction, what happens to FEV1, FVC and FEV1/FVC?
FEV1 decreased (more than FVC)
FVC decreased
FEV1/FVC decreased
in lung restriction, what happens to FEV1, FVC and FEV1/FVC?
FEV1 decreased
FVC decreased (more than FEV1)
FEV1/FVC normal or increased
what happens to total lung capacity in obstruction?
increased
in obstruction, what increases more, RV or FRC?
RV
what is the definition of restriction?
TLC<80%
how is oxygen transported through the smaller airways?
diffusion
how is oxygen transported through the major airways?
convection
what is the most important site for a diffusion impairment?
across membrane
what are the mediators of matrix degradation?
matrix metalloproteinases
how many members are in the gene family of tissue inhibitors of metalloproteinases (TIMPs)?
4
who is mainly affected by usual interstitial pneumonia?
middle aged adults
t/f... the prognosis for desquamative interstitial pneumonia is better than for usual interstitial pneumonia
true
what is the mortality from desquamative interstitial pneumonia?
30%
what type of pneumonia involves lymphocytes, plasma cells and type II hyperplasia?
non-specific interstitial pneumonia
what is the FEV1/FVC in interstitial lung disease?
normal or high
t/f... reduced compliance is a feature of interstitial lung disease
true
what are the pathological features of sarcoidosis?
mononuclear cell alveolitis, non-caseating granulomas, interstitial fibrosis
hat are some causes of alveolar haemorrhage?
idiopathic pulmonary haemosiderosis, Goodpasture's syndrome, SLE, Wegener's gramulomatosis, vasculitis associated with connective tissue disorders
What are the characteristic symptoms of ILD?
dry cough and dyspnoea
What is base excess?
calculation of base required to bring the measured pH back to 7.4 after correcting the PCO2 to 40 mmHg
What is occupational lung disease?
an abnormality of the lower respiratory system resulting from work place exposure to an offending substance/s
What is the latency period for mesothelioma?
up to 30 years
t/f... mesothelioma requires a large amount of exposure
false, small amount is sufficient
t/f... asbestosis requires a large amount of exposure
true
What is the % loss of longevity due to smoking in survivors at 75 years?
10%
What % of lip, oral cavity and pharynx cancer is linked to smoking?
~90%
What % of bladder cancer is linked to smoking?
50%
What percentage of stomach, cervix and pancreatic cancers are related to smoking?
20-30%
What are the risks to the foetus in maternal smoking?
LBW, prematurity, increased miscarriage, premature membrane rupture, placenta praevia, abruptio placentae, SIDS, lowered immune capacity
What can children get as a result of passive smoking?
SIDS, URTI, Middle ear infections, asthma
What is the effect of cigarette smoke acutely?
increase sympathetic tone, lung inflammation, decreased PO2
What is the effect of cigarette smoke, pathophysiologically?
endothelial dysfunction, atherosclerosis from inflammation (MI)
decreased mucocilliary clearance (emphysema)
What are the chronic pharmacological effects?
Induce liver enzymes, increasing break down of drugs e.g. theophyliines
Nicotinic receptor function altered ie downregulated/desensitised
Emphysema and bronchiole asthma difference?
emphysema - hyperinflation, decreased surface area as opposed to musclular contraction in asthma, use DCO to test for surface area in lung (if less = emphysema)
Dental issues associated with tobacco?
Staining, gum inflammation, black hairy tongue, oral cancer, delayed healing of gums, bad with chewing too.
What blood vessels are especially effected in smoking?
carotid, cardiac, aortic peripheral vasculature
What are the features of a post op MI in a patient who is a smoker?
less chance of chest pain, 3 days post op, and not much ST elevation
What is the increase in risk of posoperative pulmonary complications in smokers?
6 fold due to sensitised bronchioles to bronchospasm
How long should you be a non-smoker for before an operation?
at least 6 weeks, for immune function to be restored
Why do smokers get DVT/PE/thrombosis post surgically more than others?
Low O2 = EPO release in kidney = increased RBC, increased viscosity leads to increased chance of coagulation, in surgery stasis can lead to an increase chance of thrombotic events
How many times more is the risk of infection in smokers post op?
3 times
How does smoking impair immune function?
Decrease IG and IgM, impaired NK activity, worsened by surgery and anaesthetic
Why does smoking decrease wound healing post -op?
Poor microcirculation, local thromobisis, reduce O2, Cyanide impaires mitochondiral oxidative phosphorylation, inhibits collagen producing enzymes
What adjuvant drugs are used in Nicotine replacement therapy?
Bupropion - an antidepressant
Conidine - dampen sympathetic overdrive, a2 agonist
Varenicline/Champix - partial Ach-R agonist
What occurs with smoking cessation in the first 12 weeks?
Decreased CO and nicotine in 1 day, cHB and ciliary function improve in 2 days, 1-2 weeks - sputum production decreased, 4-6 wks - pulmonary function improves, 6 wks, immune fn improves, 12 wks, decreased mortality and morbidity
How long does it take for MI risk to be reduced by 50% in a person quitting smoking?
5 years
How long does it take for risk of lung cancer to be halved after quitting smoking?
10 years
Chronic bronchitis and emphysema difference clinically?
cyanosis, cor-pulmonale, heart failure - blue bloaters
pink, accessory muscle use - emphysema
What lung measurement is restrictive lung disease characterised by?
<80% TLC
t/f... compliance is increased in fibrosis/restrictive lung disease
false, compliance is decreased. That is, your ability to change volume with changes in pressure, or ability to 'expand' is deminished
What is sarcoidosis?
Multisystem disease, featuring bilateral hilar lymph node iand airway involvement, interstitial fibrosis, hypercalcaemia/uria, cardio/neuro/skin
What is the pattern of inflammation seen in CT diseases associated with interstitial lung disease?
Non-specific interstitial penumonia (NSIP) pattern is most common
(sometimes see usual intersitial penumonia (UIP) pattern or lymphocytic interstitial pneumonia (lip) pattern)
What is IPF? How gets it? how common is it? what is the survival after diagnosis?
Idiopathic pulmonary fibrosis, more likely in men >50 years, `10/100 000, 3-5 year median survival post diagnosis (no cure)
How is interstitial pulmonary fibrosis diagnosed?
Exclusion of other known ILD causes AND presence of UIP on CT AND surgical biopsy pattern
Who is more likely to get NSIP?
Women 40-50 years
t/f... NSIP is a rapdly progressive fibrotic lung disease which causes death in 3-5 years
false, Non-specific interstitial pneumonia is a slowly progressive disease, Idiopathic pulmonary fibrosis is a rapidly progressive lung disease causing death in 3-5 years, as a median.
How do you treat:IPF? NSIP?
IPF - antifibrotic therapy,
NSIP - antiinflammatory therapy +/- antifibrotic therapy
What will you find on the physical examination of someone with ILD?
inspiratory crackles at bases, inspiratory squeaks, clubbing, pulmonary HT, extrapulmonary features of underlying disorders
How are pulmonary function tests used in ILD?
used to assess disease severity.
TLC<80%
reduced FVC
elevated FEV1/FVC ratio
low DLco, preserved KCO
What are the features of a usual intersitital pneumonia pattern on CT?
lower zone reticulation, honeycombing, patchy distribution, distortion, traction bronchiectasis. (usually indicates IPF, but can also be found in RA etc)
What are the features of a non-specific intersitital pneumonia pattern on CT?
Lower zone, ofter symmetrical, ground glass opacity (predominant), reticular changes, traction bronchiectasis, no honeycombing
What are the histological feathures of Unusual Iinterstitial Pneumonia pattern?
Temporarl and geographical heterogeneity, establish fibrosis, fibroblastic foci, normal lung, peripheral and subpleural accentuation of fibrosis
What are the histological feathures of Non Specific Interstitial Pneumonia pattern?
temporally uniform, absence of honeycombing, minimal or no fibroblastic foci, cellular or fibrotic
What is pH?
-log10[H+], measurement of H+
What is the bicarbonate buffer system?
H2CO3 <-> HCO3- + H+
What is the Henderson Hasselbach equation?
pH = pK + log10([HCO]/[H2CO3])

Tells you the pH when half dissociation of acid has occurred
What is K?
What is pK?
K = [H+][HCO3]/[H2CO3]
pK = pH at half dissociation = 6.1
t/f... blood gas measurements are related back to 37 degrees, even if febrile
true
What is base excess?
The amount of excess base (+) or acid (-) in the blood, having removed abnormal influence of the lung by bringing PCO2 back to 40mmHg.
What is the scheme for ABG interpretation?
pH?
If acid and paCO2 high = respiratory
If acid, is BE low = metabolic
If alkaline, is PaCO2 low = respiratory
If alkaline is BE/HCO3 high = metabolic
Haas the other variable moved in the opposite direction? (compensation)
Is compensation partial or complete?
If ischaemic, is it due to lung disease - Ideal PAO2 = 150-paO2 - (1.25 x PaCO2)
Sample ABG
pH = 7.35
PCO2 = 67 mmHg
BE = +10mml/L
PaO2 = 44mmHg
Primary respiratory acidosis with complete metabolic compensation and a wide A-a gradient indicating V/Q mismatch - lung disease present, possible chronic obstructive lung disease with compensated repiratory acidosis
How long does it take for kidney to make changes to acid-base system?
~48 hours
sample ABG
pH = 7.38
PaCO2 = 19mmHg
BE = -13mmol/L
PaO2 = 82mmHg
Primary metabolic acidosis with complete respiratory compensation. O2 is too low for CO2 level(should be 120 if normal) therefore there is a lung disease present. Consistent with sepsis and lactic acidosis
sample ABG
pH = 7.5
PaCO2 = 44mmHg
BE = +10 mmol/L
PaO2 = 56 mmHg
Primary metabolic alkalosis with no respiratory compensation, wide A-a gradient indicating lung disease.
Corticosteroid therapy in COPD.
Diuretic therapy in pulmonary oedema
Vomiting and aspiration
t/f... alkalosis is almost always compensated for
false, paCO2 drives ventilation, not only acid, so that if CO2 is normal it will not generally increase respiration in a metabolic alkalosis, and respiratory alkalosis is usually short term so not enough time for compensation in rby metabolism
sample ABG
pH = 7.55
PaCO2 = 21mmHg
BE = -4 mmol/L
PaO2 = 117mmHg
Primary respiratory alkalosis without metabolic compensation, and with normal lung function. Perhaps hyperventilation from anxiety
sample ABG
pH = 7.49
PaCO2 = 41mmHg
BE = +7 mmol/L
paO2 = 68mmHg
Primary metabolic alkalosis, not compensated by respiratory system, wide Aa gradient so lung disease
sample ABG
pH = 7.22
PaCO2 = 63mmHg
BE = -2mmol/L
PaO2 = 64mmHg
Acute primary respiratory acidosis with no compensation, normal lung function.

Could be head injury, drug overdose, acute hypoventilation
sample ABG
pH = 7.05
paCO2 = 59mmHg
BE=13mmol/L
PaO2 = 56mmHg
Combined respiratory and metabolic acidosis, with a wide Aa gradient indicating disease

Shock, severe sepsis, ruptured spleen
What is the negative impact of giving high oxygen to premature babies?
Retinopathy - loss of placental maternal growth factors, loss of retinal vessels, suppress local growth factor production e.g. VEGF
What are oxygen sensors?
prolul hydroxylases, stabilise HIFS
Haeme oxygenase putative sensor in the carotid body
cytochorme oxidase key in o2 binding to mitochondira
What is the biochemical reason for death in low oxygen?
can't generate AP for cellular machinery
What are some ROS?
superoxide, hydrogen peroxide, hydroxyl radicals, peroxynitrite
What are some anti-ROS defence substances?
Glutathione
REdox proteins - thioredoxin and peroxiredoxin
How does glutathione protect from proxidants?
converts from GSH to GSSG, oxidising
What is the antioxidant response to hyperoxia toxicity?
high o2 = metabolism byNADPH oxidase = ROS = EGFR-dependent signal pathway = activation of NRf2 (TF) = interacts with AntioxidantResponseElements (genes)
How does our body defend against ROS induced carcinogenesis?
Induces apoptosis when there are high levels of ROS.

ROS oxidises TRX-ASK1, removing TRX and allowing ASK1 to activate p38-MAPK, which induces growth arrest and apoptosis. If p38 is impaired, then ROS can induce cancer?
What does high/normal oxygen levels in the body do to HIF?
causes Hypoxia Induced Factor proteosomal degradation in the cytosol
What are the downstream effects of HIF production?
EPO production
Metabolism change (glycolysis)
angiogenesis
cell survival
O2 delivery
How does low O2 promote glycolysis?
Low O2 = HIF stabilisation = enhanced PDK expression = inhibition of PDH = Puruvate does not enter citric acid cycle, but is instead retained in the cytoplasm to be converted into lactate
How do hydrogen sulfide levels rise in hypoxia?
CSE synthesises Hydrogen sulfide.

Low oxygen = decreased activity of Haeme oxygenase, that breaks down haem into bilirubin. this process has a by product of CO. CO inhibits CSE, so in low O2, normally suppressed CSE is allowed to produce hydrogen sulfide