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114 Cards in this Set
- Front
- Back
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what part of the conducting zone is cartilage present
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trachea and bronchi
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associated with anatomic dead space
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conducting zone
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respiratory zone
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respiratory bronchioles
alveolar ducts alveoli |
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where does conducting zone end
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terminal bronchioles
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where do goblet cells end in conducting zone
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bronchi
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where does pseudostratified ciliated columnar cells extend to
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respiratory bronchioles
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what lecithin-to-sphingomyelin ratio indicates fetal lung maturity
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ratrio of > 2.0
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which type of pneumocyte is the majority of alveolar surface and is optimal for gas diffusion due to being thin
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type I pneumocytes
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these pneumocytes secrete surfactant which decreases alveolar surface tension
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type II pneumocytes
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dipalmitoyl phosphatidylcholine
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surfactant
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these pneumocytes proliferate during lung damage and can serve as precursors for type I penumocytes
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type II
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nonciliated columnar cells with secretory granules that secrete a component of surfactant, degrade toxins, and act as reserve cells
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Clara cells
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what does a bronchopulmonary segment consist of
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tertiary bronchus
2 arteries (bronchial and pulmonary) located in the center veins and lymphatics drain along the borders |
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lobes of right and left lung
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right - 3 lobes
left - 2 lobes and lingula |
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where does an foreign body aspirate while upright vs. supine
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upright - lower portion of right inferior lobe
supine - superior portion of right inferior lobe |
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relation of the pulmonary artery to the bronchus of each lung
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right lung - pulmonary artery is found anteriorly
left lung - pulmonary artery is found superiorly |
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structures perforating the diaphragm at T8, T10, and T12
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T8 - IVC
T10 - esophagus and vagus T12 - aorta, thoracic duct, and azygous vein |
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what is the diaphragm innervated by
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phrenic nerve C3-5
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where can pain from diaphragm be referred to
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shoulder
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tendency for an alveolus to collapse on expiration increases due to
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decreasing alveolar radius
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what part of the lung is the largest contributor of functional dead space
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apex of lung
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calculation of physiologic dead space
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tidal volume x (PaCO2 - PeCO2)/(PaCO2)
*PeCO2 = expired air PCO2 |
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anatomical dead space of conduction airways plus functional dead space in alveoli
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physiologic dead space
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what is the natural tendency of the lungs and chest wall
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lungs want to collapse
chest wall wants to spring outward |
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what three things decrease lung compliance
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1. pulmonary fibrosis
2. decreased surfactant 3. pulmonary edema |
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airway and alveolar pressure at FRC
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0 - both lungs and chest wall are balanced
system pressure = atmospheric |
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differentiate T and R forms of hemoglobin
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T (taut) has low affinity for O2
R (relaxed) has high affinity for O2 |
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why does fetal hemoglobin has higher affinity for O2
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lower affinity for 2,3-BPG than adult and therefore higher affinity for O2
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what shifts the O2-dissociation curve to the right favoring T form over R
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increased H
increased CO2 increased 2,3-BPG increased temperature |
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what can methemoglobinemia be treated with
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methylene blue
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oxidized form of hemoglobin that does not bind O2 as readily, but has increased affinity for CN
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methemoglobin
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two things used to treat cyanide poisoning
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1. nitrites to oxidize hemoglobin to methemoglobin allowing cytochrome oxidase to function
2. thiosulfate to bind cyanide forming thiocyanate |
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binds to O2 with very high affinity and causes decreased oxygen-binding capacity with a left shift in the oxygen-hemoglobin dissociation curve decreasing unloading of oxygen
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CO
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what makes O2-dissociation curve shift to left or right
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right - increase in everything except pH (H, CO2, T, DPG, Altitude)
left - decrease in everything except pH |
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what does a decrease in PAO2 do to pulmonary vessels
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causes vasoconstriction and shift blood away from poorly ventilated region of lung to well ventilated regions
*unlike systemic circulation which causes vasodilation |
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gas diffusion equation
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V = A/T x Dk(P1 - P2)
*emphysema decreases A *pulmonary fibrosis increases T |
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perfusion limited gases
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CO2 and N2O
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diffusion limited gase
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CO
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what does pulmonary HTN do to pulmonary arteries
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results in atherosclerosis, medial hypertrophy, and intimal fibrosis
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primary pulmonary fibrsosis
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due to inactivating mutation in the BMPR2 gene - normally function to inhibit vascular smooth muscle proliferation
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causes of secondary pulmonary fibrosis
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COPD, mitral stenosis, thromboemboli, autoimmune (SLE, CREST), left-to-right shunting, sleep apnea
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most important determinant for pulmonary resistance
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radius - multiplied to the fourth power
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pulmonary vascular resistance equation
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PVR = P(PA) - P(LA) / CO
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normal O2 binding capacity
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~20.1 mL O2/dL
*15 g/dL of hemoglobin x 1.34 mL O2 that each gram of Hb can bind |
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what happens to the O2 content, O2 saturation, and PO2 when Hb concentration falls
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decreased O2 content
O2 saturation and PO2 remain the same |
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what does O2 content equal
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(O2 binding capacity x % saturation) + dissolved O2
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Alveolar gas equation
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PAO2 = PIO2 - (PACO2/R)
*can be approximated to 150-PACO2/0.8 |
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normal (A-a)O2 in lungs
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10-15 mmHg
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three general causes for oxygen deprivation
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1. hypoxemia (decreased PaO2)
2. Hpoxia (decreased O2 delivery to tissue) 3. Ischemia |
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causes of hypoxemia and A-a gradient associated with each
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high altitude (normal A-a)
hypoventilation (normal A-a) V/Q mismatch (increased A-a) diffusion limitation (increased A-a) right-to-left shunt (increased A-a) |
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causes of hypoxia
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decreased CO
hypoxemia anemia cyanide poisoning CO poisoning |
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ideal V/Q ratio
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1, ventilation should match perfusion
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what is the average V/Q ratio of the apex vs. base of lungs
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apex - V/Q = 3 (wasted ventilation)
base - V/Q = 0.6 (wasted perfusion) |
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what part of the lung both greater perfusion and ventilation
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base of lung
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why does TB prefer apex of lung
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higher O2 content
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V/Q ratio in shunt, does 100% O2 improve PO2
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V/Q = 0, 100% O2 does nothing to PO2
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V/Q ratio in physiologic dead space, does 100% O2 improve PO2
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V/Q = infinity, 100% O2 helps improve PO2
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what happens to capillaries in the apex of the lung
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compressed due to higher alveolar pressure
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how does CO2 bind to hemoglobin compared to O2
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binds to N terminus of globin, not the heme
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Haldane effect
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oxygenation of Hb promotes dissociation of H from Hb shifting equilibrium toward CO2 formation and releases CO2 from RBC
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physiologic response to high altitude
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1. increase ventilation
2. increase EPO 3. increase 2,3-DPG 4. increase renal excretion of bicarb 5. pulmonary vasoconstriction |
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what happens to V/Q in the apex of lung during exercise
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approaches 1 due to vasodilation of capillaries (normally they are compressed by higher pressure)
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emboli associated with long bone fractures
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fat emboli
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emboli associated with DIC, especially postpartum
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amniotic fluid emboli
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Virchow's triad for being predisposed to developing DVT
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1. stasis
2. hypercoagulability 3. endothelial damage |
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associated with increased RV and decreased FVC (same as VC), hallmark is decreased FEV1/FVC ratio
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obstructive lung disease (COPD)
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gland depth/total thickness of bronchial wall
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Reid index
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associated with hypertrophy of mucus-secreting glands in bronchioles resulting in increased Reid index > 50%; productive cough
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chronic bronchitis
"blue bloater" |
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COPD associated with wheezing, crackles, and cyanosis
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chronic bronchitis
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associated with enlargement of air spaces and decreased recoil from destruction of alveolar walls, increased compliance
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emphysema
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what causes the increased compliance and destruction of alveolar walls in emphysema
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increased elastase activity
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differentiate cause of centriacinar vs. panacinar emphysema
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centriacinar - smoking
panacinar - a1-antitrypsin deficiency |
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paraseptal emphysema
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associated with bullae that can rupture and yeild spontaneous pneumothorax
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clinical findings in emphysema
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dyspnea
decreased breath sounds tachycardia late-onset hypoxemia *chronic bronchitis has early-onset hypoxemia |
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bronchial hyperresponsiveness causes reversible bronchoconstriction
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asthma
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what can trigger asthma
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viral URI
allergens |
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chronic necrotizing infection of bronchi resulting in permanently dilated airways and purulent sputum
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bronchiectasis
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associated with bronchial obstruction, CF, poor ciliary motility, and can develop aspergillosis
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bronchiectasis
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associated with decreased FVC and TLC with FEV1/FVC ratio > 80%
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restrictive lung disease
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three pneumoconioses and where they each affect
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coal miner's - upper lobes
silicosis - upper lobes asbestosis - lower lobes |
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associated with eggshell calcification of hilar lymph nodes and fibrosis due to macrophages responses to foreign body
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silicosis
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this can disrupt phagolysosomes and impair macrophages increasing susceptibility to TB
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silica
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associated with calcified pleural plaqes and increased incidence of bronchogenic carcinoma and mesothelioma
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asbestosis
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golden-brown fusiform rods resembing dumbbells located inside macrophages
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abestos bodies
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lecithin-to-sphingomyelin ratio in neonatal RDS
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usually < 1.5
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what can therapeutic supplemental O2 result in in neonates with RDS
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retinopathy of prematurity
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risk factors for neonatal RDS
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prematurity
maternal diabetes (elevated insulin) cesarean delivery (decreased release of fetal glucocorticoids) |
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associated with diffuse alveolar damage leading to increased alveolar capillary permeability and protein-rich leakage into alveoli
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ARDS
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initial damage in ARDS
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neutrophilic substances toxic to alveolar wall causing alveolar damage
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normal FEV1/FVC ratio
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80%
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what happens to FEV1 and FVC in both obstruction and restriction lung diseases
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both are decreaes; however in obstructive, FEV1 is more dramatically reduced
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differentiate central vs. obstructive sleep apnea
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central - no respiratory effort
obstructive - respiratory effort against airway obstruction |
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differentiate tracheal deviation in bronchial obstruction vs. tension pneumothorax
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bronchial obstruction - toward side of lesion
tension pneumothorax - away from side of lesion |
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associated with hyperresonant percusion and decreased breath sounds and tactile fremitus
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tension pneumothorax
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associated with bronchial breath sounds over lesion with dullness to percussion and increased VTF
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lobar pneumonia
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associated with decreased breath sounds over lesion with dullness to percussion and decreased VTF
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pleural effusion
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associated with absent breath sounds, dullness to percussion and decreased VTF
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bronchial obstruction
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common cancers that metatasize to the lung
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breast
colon prostate bladder |
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lung cancer associated with central location and related to smoking
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squamous cell carcinoma
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lung cancer associated with parathyroid-like activity
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squamous cell carcinoma
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lung carcinoma not associated with smoking and females, located peripherally, and develops in sites of prior pulmonary inflammation of injury
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adenocarcinoma of lung
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histology of this lung carcinoma yields clara cells becoming type II pneumocytes
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adenocarcinoma of lung
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centrally located, undifferentiated lung carcinoma that is associated with ectopic production of ACTH or ADH
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small cell carcinoma
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inoperable lung carcinoma
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small cell carcinoma
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highly anaplastic undifferentiated lung carcinoma located in the periphery
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large cell carcinoma
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malignancy of the pleura associated with asbestosis, results in hemorrhagic pleural effusions and pleural thickening
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mesothioma
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psammoma bodies are seen in this lung malignancy
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mesothioloma
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carcinoma that occurs in the apex of the lung and may affect cervical sympathetic plexus and Horner's syndrome
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pancoast's tumor
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associated with ptosis, miosis, and anhidrosis
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Horner's syndrome
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two organisms associated with lobar pneumonia
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strep pneumo
klebsiella |
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organisms associated with bronchopneumonia
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S. aureus
H. influenzae Klebsiella S. pyogenes |
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organisms associated with interstitial (atypical) pneumonia
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RSV
adenovirus mycoplasma legionella chlamydia |
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pleural effusion with milky fluid high in triglycerides
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lymphatic effusion
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pleural effusion associated with malignancy, pneumonia, and trauma
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exudate - increased protein content
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