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130 Cards in this Set
- Front
- Back
COPD disorder morphologically manifested by bronchial smooth muscle
hypertrophy,hyperplasia of goblet cells,thickening & hyalinization of basement membranes,proliferation of eosinophils & intrabronchial mucous plugs |
Bronchial asthma
-Curshmann Spirals(whorl-like form. of epithelial cells);Charcot-Leyden Crystals(crystalloids of eosinophil-derived proteins) |
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COPD disorder presenting w/ productive cough lasting at least 3 consecutive months over at least 2 consecutive years charact. by hypersecretion of mucus due to hyperplasia of mucus-secreting submucosal glands
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Chronic Bronchitis
-assoc. w/ cigarette smoking,air pollution,infxn.,& genetic factors |
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Chills, fever, malaise, pleuritic pain, & rusty sputum
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Pneumonia
->90% of lobar pneumonia is caused by Strep. pneumoniae; bronchopneumonia shows patchy consolidation |
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Dilatation of air spaces w/ s
destruction of alveolar walls |
Emphysema
-results from accelerated protease & elastase destruction of the lung |
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Harmless black pigment in the lungs
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Anthracosis
-common in coalminers, urban dwellers, or smokers |
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Most common malignant tumor of the larynyx seen often in men >40yrs who cigarette smoke & drink alcohol
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Squamous Cell Carcinoma
-symptoms of persistent hoarseness |
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Persistent productive cough for at least 3 consecutive months in at least 2 consecutive years
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Chronic Bronchitis
-incr. Reid index, w/c is a ratio of the thickness of the mucosal gland to the thickness of bronchiolar wall |
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Copious purulent sputum, hemoptysis, & recurrent lung infections w/c may lead to abscess
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Bronchiectasis
-bronchi & bronchioles can be dilated up to 4 times normal size |
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Lung tumors w/ strongest correlation to smoking
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Small cell carcinoma & Squamous cell carcinoma of the lung
-both types localize near the hilus(centrally) |
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Most prevalent chronic occupational disease in the world
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Silicosis
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Noncaseating granulomas in the lungs often in a young, adult, African American female
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Sarcoidosis
-may be detected incidentally as bilateral hilar adenopathy |
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Embolism obstructing the bifurcation of the pulmonary artery
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Saddle embolus
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Cause of sudden death often in immobalized postoperative patients
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Pulmonary Embolism
-thrombi are most often from the deep veins of the lower ext. |
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Pulmonary vascular dse. caused by inc. hydrostatic presssure(left vent. failure,inc. alveolar capillary permeability(infl. alveolar rxn due to inhalation of toxic subst.), & by rapid ascent to high altitude
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Pulmonary Edema
-intra-alveolar accumulation of fluid |
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Alpha-1-antitrypsin deficiency
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Panacinar emphysema
-alpha-1-antitrypsin inhibits proteases, particularly elastase |
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Assoc. w/ asbestos exposure
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Malignant Mesothelioma
-neoplasm of visceral or parietal pleura or peritoneal neoplasm |
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Severe dyspnea, wheezing, hyperactive airways, & bronchospasm triggered by various stimuli
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Bronchial asthma
-most commonly IgE mediated, Type I hypersensitivty rxn. in the lung |
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Pulmonary vascular dse. cuased by COPD,inc. pulmonary bld. flow(cong. L-R shunt),inc.resistance w/in the pulmonary circl.(embolus or vasoconstriction due to hypoxia),inc. bld. viscosity(polycythemia)
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Secondary pulmonary hypertension
-more common than Primary(unknown etiology,poor prognosis) |
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Restrictive Pulmonary Dse
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Adult Resp. Distress Synd.(diffuse alveolar damage), pneumoconiosis, silicosis, sarcoidosis
-reduced total lung capacity bec. of dec. expansion of lung parenchyma |
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Rapid onset of resp. insufficiency refractory to oxygen therapy assoc. w/ sepsis, infxn., aspiration, or trauma
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Adult resp. distress syndrome(diffuse alveolar damage)
-histologically characterized by intra-alveolar hyaline membranes |
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Most common bronchogenic carcinoma type in women & nonsmokers
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Adenocarcinoma of the lung
-localize peripherally |
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Fever, night sweats, weight loss, & hemoptysis
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Tuberculosis(TB)
-Ghon complex in primary TB, cavitary lesions in the lung apices in secondary TB |
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Tumor assoc. w/ hypercalcimia due to elaboration of parathyroid hormone-related peptide
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Squamous cell carcinoma of the lung
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Rupture of apical subpleural blebs in young px.
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Spontaneous idiopathic Pneumothorax
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Blue bloater
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Chronic Bronchitis
-Cyanosis resulting from severe hypoxia |
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Heart Failure Cells
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Chronic passive congestion of the lung
-Hemosiderin-laden macrophages |
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Neoplastic columnar & cuboidal epithelial cells that line the alveolar septa
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Bronchioloalveolar Carcinoma
-tumor cells are also found loose in alveolar spaces |
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Assoc. w/ SIADH & Cushing syndrome as paraneoplastic syndromes
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Small Cell Carcinoma
-has the worst prognosis of bronchogenic carcinoma subtypes |
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Chronic Obstructive Pulmonary diseases
(COPD) |
Emphysema, chronic bronchitis, bronchieactasis, & bronchial asthma
-caused by airway narrowing or loss of elastic recoil of the lung, resulting in decreased forced expiratory volume at 1sec. |
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Pink Puffer
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Emphysema
-px. who overventilates & remains well-oxygenated |
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Central region of caseating necrosis encicled by lymphocytes, plasma cellms, & epitheloid cells
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Granulomatous Inflamation
-found in TB, fungal infxn., foreign body, & sarcoidosis |
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2 types of bronchial asthma
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1)Extrinsic(immune)asthma:type I hypersensitivity response involving
Ige bound to mast cells;childhood; family hx. of allergies 2)Intrinsic(nonimmune)asthma:assoc. w/ chronic bronchitis,exercise or cold induced asthma & other asthma variants;adult life;no family hx. of allergies |
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A group of resp. disorders charact. by airflow obstruction,dec.
FEV1/FVC ratio |
Chronic Obstructive Pulmonary Dse.(COPD)
-Bronchial asthma,chronic bronchitis, pulmonary emphysema,bronchiectasis |
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Benign neoplasm of the larynx located in the true vocal cords w/c
could be caused by HPV in children |
Laryngeal papilloma
-occur singly & may under go malignant change in adults |
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Malignant tumors of the nose & nasal sinuses
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Nasopharyngeal carcinoma(EBV),Squamous Cell Carcinoma(most common nasal tumor),Adenocarcinoma(5% of malignant tumors),Plasmacytoma(plasma cell neoplasm)
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Most common upper resp. tract disorder caused by viruses manifested by coryza,sneezing,nasal congestion, & mild sore throat
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Common Cold
-Adenovirus is most common virus |
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Tumor of the larynx located in the true vocal cords presenting as a benign laryngeal polyp induced by chronic irritation(excessive use of voice,heavy cigarette smoking)
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Singer's nodule
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Upper resp. tract illness mediated by IgE type I immune reaction involving mucosal & submucosal mast cells characterized by inc. eosinophils in peripheral bld. & nasal discharge
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Allergic Rhinitis
|
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A localized area of suppuration in the parenchyma due to bronchial obstruction(often by cancer),aspiration of gastric contents,complication of bact. pneumonia & is seen in px. who aspirate during loss of consciouseness(drug overdose,neurologic disorders)
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Lung Abscess
-manifest as fever,foul smelling purulent sputum, & x-ray evidence of fluid filled cavity |
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An acute viral infxn. charact. by inflammation of the larynx,
trachea, & epiglottis that is life-threatening in infants |
Acute laryngotracheobronchitis(croup)
-symptoms of harsh cough & inspiratory stridor |
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COPD characterized by copious foul smelling purulent sputum,hemoptysis, recurrent pulmonary infxn. w/c may lead to lung abscess
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Bronchiectasis
-assoc. w/ bronchial obstruction, cystic fibrosis,intralobar sequestration of the lung,necrotizing pneumonia |
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4 types of emphysema
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Centrilobar(dilation of resp. bronchioles,localized to upper lobes,Coal Worker's Pneumoconiosis); Panacinar(dilatation of entire acinus, alveoli,alveolar ducts,resp. bronchioles,terminal bronchioles); Paraseptal(dilatation of distal part of acinus,localized to pleura & interlobar septa,assoc. w/ subpleural bullae or blebs); Irregular(most common,asymptomatic,irregular involvement of the acinus w/ scarring w/in the walls)
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Type of emphysema assoc. w/ loss of elasticity due to alpha1-antitrypsin def.(alpha1-protease inhib.)
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Panacinar Emphysema
-affects lower zones;most severe at the base |
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Causes of Emphysema
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Effect of elastase(neutralized by alpha1-antitrypsin) w/c induces destruction of elastin on the alveolar wall;Cigarette smoking(attracts neutrophil & macrophages,sources of elastase);Hereditary Alpha1-antitrypsin def.(piZ allele,homozygous state-piZZ)
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COPD characterized by permanent abnormal bronchial dilation often in the lower lobes of both lungs due to chronic infxn.,inflammation & necrosis of the bronchial wall
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Bronchiectasis
-predisposed by bronchial obstruction(tumor) & chronic sinusitis w/ postnasal drip |
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Synd. manifested by bronchiectasis, sinusitis,situs inversus,hearing loss,male sterility, caused by defective motility in celia located in the resp.,auditory,& sperm
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Kartegener Synd.
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Restrictive pulmonary dse. produced by diffuse alveolar damage(alveolar capillary permeab.~leakage of protein-rich fluid into the alveoli) & form. of intra-alveolar hyaline memb. resulting in severe imparement of resp. gas exchange
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Adult resp. distress synd.(ARDS)
|
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Most common cause of resp. failure in newborn & death in premature infants due to surfactant(dipalmitoyl lecithin;secreted by type II pneunocytes)def. presenting w/ dyspnea,cyanosis,tachypnea at birth
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Neonatal resp.distress synd.(hyaline membrane dse)
-predisposed by prematurity,maternal diabetes mellitus,birth by cesarean section |
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Complications & assoc. conditions in neonatal resp. distress synd
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Bronchopulmonary dysplasia(due to tx. w/ high conc. of O2 & mech. vent.); Patent ductus arteriosus(failure of closure of the ductus due to immaturity & hypoxia);Intraventricular brain hemorrgh.;Necrotizing enterocolitis(fulminant infl. of small & large intest.)
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Environmental disease caused by inhalation of inorganic dust particles exemplified in Anthracosis,Coal worker's pneumoconiosis,Silicosis, & Asbestosis
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Pneumoconioses
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Vol. of insp. or exp. air w/ normal breath;vol. insp. above the tidal vol.; vol. exp. after expiration of tidal vol.;vol. in the lungs after max. expiration
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Tidal Vol.;Inspiratory reserve vol.; Expiratory reserve vol.;Residual vol.(cannot be measured by spirometry)
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Defined as the vol. in the lungs that does not participate in gas exchange; functional measurement;greater than anatomical dead space in lung dse.
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Physiologic Dead Space=Tidal vol.[(PCO2 of art. bld.mmHg-PCO2 of expired air mmHg)/PCO2 of art bld.]
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Equation for alveolar vent.
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Alveolar vent=(Tidal vol-Dead space)breaths/min
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Sum of Tidal vol+IRV;sum of ERV+ residual vol.;sum of tidal vol.,IRV,& ERV;vol. of air forcibly expired after max. inspiration;Sum of all four lung vol.
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Inspiratory capcity;Functional residual Capacity(cannot be measured by spirometry);Vital Capacity;Total Lung Capacity(cannot be measured by spirometry)
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A variant of Coal worker's pmeumoconiosis caused by inhalation of coal dust resulting in fibrotic nodules filled w/ necrotic black fluid w/c can result in bronchiectasis, pulmonary HPN,death due to resp. failure or right sided heart failure
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Progressive massive fibrosis
-compared to "simple coal worker's pneumoconiosis" w/c produce no disability |
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An occupational lung dse. caused by inhilation of silica dust~ingestion by alveolar macrophage~damage to macrophage causes a infl. response; form. of silicot nodules w/c obstruct the airways & bld. vessels
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Silicosis
-assoc w/ inc. susceptibilty to tuberculosis(silicotuberculosis) |
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An occupational lung dse due to uptake of asbestos by alveolar macrophage~ release of fibroblast stimulating growth factors~diffuse interstitial fibrosis(lower lobes) w/c predisposes to bronchogenic carcinoma & malignant mesothelioma
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Asbestosis
-charact. by Ferruginous bodies(yellow-brown,rod-shape bodies w/ clubbed ends) & Hyalinized fibrocalcific plaques of the parietal pleura |
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Restrictive lung dse. of unknown etiology charact. by noncaseating granulomas involving multiple organ systems often presenting in early adult years in px. of African lineage
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Sarcoidosis
-abn. findings of bilateral hilar lymphadenopathy,interstitial lung dse. presenting as diffuse reticular densities,hypercalcemia,hypercalciuria, hypergammaglobulinemia,inc. ACE activity |
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Common pathologic changes in sacoidosis
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Interstitial lung dse.,enlarged hilar lymph nodes,ant. uveitis,erythema nodusom of the skin,polyarthritis
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6 types of interstitial lung dse.
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Hypersensitvity pneumonitis(extrinsic allergic alveolitis),Goodpasture synd.,Idiopathic pulmonary hemosiderosis,Eosinophilic granuloma, Idiopathic Pulmonary fibrosis, Sarcoidosis
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Interstitial lung dse. due to proliferation of histiocytic cells w/c have cytoplasmic inclusions(Birbeck granules)resembling tennis rackets
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Eosinophilic granuloma
-found in the lung or in bony sites(ribs) |
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Pulmonary vascular dse. found in >50% of all autopsies often resulting from DVT or assoc. w/ venous stasis,CHF, prolonged bed rest or sitting & may result in hemorrhagic(red)infarcts
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Pulmonary embolism
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Pulmonary infxn. charact. by fever & chills,productive cough,blood-tinged or rusty sputum,pleuritic pain,hypoxia w/ shortness of breath all due to an infl. process of infectious origin affecting the pulmonary parenchyma
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Pneumonia
-occurs in 3 morphologic & clinical patterns(lobar,broncho,interstitial) |
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Type of pneumonia often caused by Streptococcus pneumoniae(pneumococus) w/c involves the entire lobe & charact. by intra-alveolar exudate
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Lobar Pneumonia
-if not tx.,morphologically evolve in 4 stages(congestion,red hepatization, gray hepatization,resolution) |
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Type of pneumonia caused by many organisms charact. by patchy infl. involving one or more lobes w/ infl. infiltrates extending from the bronhioles to adjacent alveoli
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Bronchopneumonia
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Type of pneumonia commonly caused by Mycoplasma pneumonia or viruses charact. by diffuse,patchy infl. localized to interstitial areas of alveolar walls
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Interstitial(primary atypical)pneumonia
-Mycoplasma pneumonia is most common form |
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Most common form of interstitial pneumonia w/c may occur in epidemics in children-young adults w/ an insidous onset & self-limited course charact. by infl. in the interstitium w/ no exudate in alveolar space, & intra-alveolar hyaline memb.
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Mycoplasma Pneumonia
-diagnosed by sputum cultures & assoc. w/ nonspecific cold agglutinins(used to provide early diagnostic information) |
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Most common types of pneumonia in childhood caused most commonly by influenza virus,adenovirus,rhinovirus, RSV
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Viral Pneumonia
-may also arise from rubeola(measles) producing Giant Cell Pneumonia & varicella(chickenpox) |
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Most common form of Ricketsial pneumonia caused by Coxiella bunettii in people who work near cattle or sheep,inhale the organism,or drink unpasteurized milk
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Q fever
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Most common opportunistic infxn. in AIDS px. caused by P.carinii
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Pneumocystis carinii pneumonia
-diagnosed by biopsy or bronchial washing specimens |
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Pulmonary infxn. occuring world wide charact. by Ghon complex(subpleural parenchymal lesion w/ involve hilar lymph nodes),central caseous necrosis often by Langhan giant cells w/c could be seen on x-ray
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Primary Tuberculosis
-asymptomatic;does not progress to clinically evident dse. |
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Type of tuberculosis w/c results from activation of the Gohn complex resulting in localixed lesions on the apical lobes & hilar lymph nodes, tubercle form.,cavitary lesions, scarring,calcification & metastasis(miliary tuberculosis,extrapulmonary tuberculosis)
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Secondary Tuberculois
-cavitary lesion is charact.; extrapulmonary tuberculosis include tuberculous meningitis,Pott dse. of the spine,paravertebral abscess, or psoas abscess |
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Immune mech. in pathogenesis of tuberculosis
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Ingestion of tubercle bacilli by macrophage(presentation of antigens to CD4 Th1 Tcells in context of class II MHC mol.)~proliferation of CD4+ Tcells & secretion of cytokines;some macrophage are transformed to epithelioid cells & Langhans multinucleated giant cells;caseous necrosis due to action of cytokines secondary to immunologically stimulated cells
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Progressive diability,fever, hemoptysis,pleural effusion(often bloody & generalized wasting are all clinical charact. of this pulmonary infxn.
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Secondary Tuberculosis
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A delayed hypersensitivity response w/c is positive in primary & secondary tuberculosis,represents hypersensitivity & relative immunity, & remains positive throughout life
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Positive Tuberculin skin result
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Occurs in primary & disseminated forms; fungal spherules containing endospores found w/in granulomas
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Coccidioidomycosis
-caused by Coccidioides immitis |
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Pulmonary infxn. similar to tuberculosis;occurs in primary & secondary forms;results in multiple pulmonary lesions w/ late calcification;dissiminated form marked by multisystem involvement w/ infiltrates of macrophages filled w/ fungal yeast forms
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Histoplasmosis
-caused by Histoplasma capsulatum |
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Typical pulmonary opportunistic infxn.; may disseminate to the brain; caused by a gram post. aerobic, filamentous,weakly acid-fast bacteria closely related to Actinomyces
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Nocardiosis
-caused by Nocardia |
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Pulmonary infxn. w/c begun in the lungs w/c may produce meningitis; etiological agent is charact. by encapsulated appearance visualized in India ink
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Cryptococcosis
-Cryptococcocus neoformans |
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Pulmonary infxn. charact. by a predilection for growth into vessels, w/ consequent widespread hematogenouse dissemination
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Aspergillosis
-caused by Aspergillus |
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Pulmonary infxn. in immunocompromised px.;invasive form produces blood borne dissemination;pulmonary,renal,hepatic abscesses & vegetative endocarditis
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Candidiasis
-caused by Candida albicans |
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Pulmonary infxn. charact. by abscess & sinus tract form.;exudate containing charact. sulfur granules,yellow clumps of the organism
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Actinomycosis
-caused by Actinomyces |
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Bronchogenic carcinoma located centrally appearing as a hilar mass often resulting in cavitation;assoc. w/ smoking;marked by inappropriate PTH-like activity w/ resultant hypercalcemia
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Squamous cell carcinoma
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Bronchogenic carcinoma located peripherally w/c develop on site of prior pulmonary infl. or injury(scar carcinoma);less clearly linked to smoking
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Adenocarcinoma Bronchial-derived
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Bronchogenic carcinoma located peripherally less clearly related to smoking;columnar-to-cuboidal tumor cells line alveolar walls;multiple densities on x-ray,mimicking pneumonia
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Bronchioalveolar carcinoma
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Most aggressive bronchogenic carcinoma least likely to by cured by surgery; usually already metastatic at diagnosis;assoc. w/ectopic production of ACTCH or ADH
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Small Cell(oat cell)carcinoma
-undifferentiated tumor |
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Carcinoma of the lung located in major bronchi;have low malignancy, spreading by direct extension into adjacent tissues
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Carcinoid carcinoma
-may result in carcinoid synd. |
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Leading cause of death from cancer in both men & women;directly proportional to the # of cigarrets smoked daily & # of years smoking;has 5 year survival rate of less than 10%;manifest as cough,hemoptasis,brochial obstruction, atelectasis & pneumonitis
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Bronchogenic Carcinoma
-spreads by local extension to the pleura,pericardium, or ribs |
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Classification of Bronchogenic carcinoma
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Subclassified into squamous cell carcinoma,adenocarcinoma(including bronchioalveolar carcinoma),small cell carcinoma, & large cell carcinoma;for therapeutic purposes,subclassified into small cell carcinoma(not surgically tx.) & non-small cell(can consider surgical tx)
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Clinical features of Bronchogenic carcinoma
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Superior Vena Cava synd.,Pancoast tumor w/ Horner synd.,hoarseness(recurrent laryngeal nerve paralysis), pleural effusion(bloody), Paraneoplastic endocrine synd.
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Volume of air exp. in 1sec. after max inspiration after max. inspiration; normally 80% of the forced vital capacity(FEV1/FVC=.8)
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Forced expiratory vol(FEV1)
-in restrictive lung dse.(fibrosis), both FEV1 & FVC are reduced;in obstructive lung dse.(asthma),FEV1 is reduced more than FVC~FEV1/FVC is decreased |
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Causes of dec. lung compliance
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High expanding pressures,inc. pulmonary venous pressure,fibrosis(deposition of collagen),lack of surfactant
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Causes of increased lung compliance
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Emphysema(dec. elastic fibers),age
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Describes the distensibility of the lungs & chest wall;inversely related to elastance;slope of the pressure-vol. curve;change in vol. for a given change in transmural press.(alveolar press.-intrapleural press.)
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Compliance of the lung
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Results from the attracive forces betw. molecules of liquid lining the alveoli;creates a collapsing pressure directly proportional to surface tension & inversely proportional to alveolar radius(Laplace's law)
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Surface Tension of the alveoli
-Collapsing press. on alveolus=[2(surface tension)/radius of the alveolus] |
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Reduces surface tension;inc. compliance;synthesized by type II alveolar cells;consist of dipalmitoyl phosphatidylcholine(DPPC);present in the fetus by 35th wk of gestation
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Surfactant
-a lecithin:sphingomyelin ratio >2:1 in amniotic fluid reflects mature levels of surfactant |
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Driven by & directly proportional to the pressure difference betw. mouth & alveoli;inversely proportional to airway resistance~the higher the resistance,the lower the airflow
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Air flow=Press. diff. betw. mouth & alveoli/airway resistance
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Described by Poiseuille's law
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Resistance to airways=[8(vicosity of insp. gas)length of airway]/[3.14(radius of the airway)to the 4th]
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Major site of airway resistance
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Medium size bronchi
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Method w/c is used to measure intrapleural pressure
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Ballon catheter in the esophagus
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Description of pressure & flow at rest(before inspiratory begins)
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Alveolar press.=atmospheric press.(alveolar press. is 0);Intrapleural pressure is neg.;lung vol.is FRC
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Description of pressure & airflow during inspiration
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Contraction of inspiratory muscles~inc. thoracic vol.~dec. alveolar press less than atmosph. press.(pressure gradient);intrapleural press. bec.more neg.;lung vol. increases by 1 tidal vol.
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Description of pressures & airflow in expiration
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Alveolar press. > atmosph. press. due to elastic forces of the lung; Intrapleural press. returns to its resting value during a normal(passsive)expiration;during forced expiration, intrapleural press. bec. (+) w/c compresses the airways & makes exp. difficult;lung vol. return to FRC
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Perfusion-limited exchange
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Under normal conditions,N2O & O2 equilibrates early along the length of pulmonary capillary(equal of partial pressure betw. alveolar air & art. bld.)~diffusion of gas can be inc. if bld. flow is inc.
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Diffusion-limited exchange
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Occurs w/ CO2 & O2 during strenous exercise & in dse. states:Fibrosis(thickening of alveolar memb. w/c inc. diffusion distance restricts O2 diffuson);Emphysema(decrease surface area for diffusion);gas does not equilibrate by the time bld. reaches the end of the pulm. art.
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Responsible for making adult hemoglobin less attractive to O2 as compared to fetal hemoglobin.
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2,3-diphosphoglycerate(DPG)
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Max. amount of O2 that can be bound to hemoglobin;determined by hemoglobin conc. in bld.;limits the amount of O2 carried;measured at 100% saturaion
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O2 Capacity
-compared to O2 Content w/c is total amount of O2 carried in bld(bound & dissolve O2). |
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Depends on the hemoglobin conc.,the PO2, & the P50 of hemoglobin
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O2 Content=[O2-binding capacity(ml O2/100 ml bld.)(%sat.)]+ Dissolved O2(ml O2/100 ml bld.)
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"Positive cooperativity" in relation to sigmoid shape on the curve
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There is inc. affinity for O2 by hemoglobin for every binding of O2 to a heme site~the affinity for the 4th O2 mol. is the highest;flattening of the curve occurs @ PO2 of 60-100mmHg
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Shift to the right in the hemoglobin-O2 dissociation curve
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Affinity of hemoglobin for O2 is dec., P50 is inc.;Inc. in PCO2 or dec. in pH(Bohr effect);inc. in temp.;inc. in 2,3-DPG conc.(adaptaion to chronic hypoxemia)
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Shift to the left in the Hemoglobin-O2 dissociation curve
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Affinity fo hemoglobin for O2 is inc.; P50 is dec.;dec. PCO2;inc. pH;dec. temp.;dec. 2,3-DPG conc.;dec. affinity of HbF for 2,3-DPG inc. O2 affinity; carbon monxide poisoning(hemoglobin %sat. stays at 50%)
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3 forms in w/c CO2 is transported
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Dissolved CO2(small amount), Carbaminohemoglobin(CO2 bound to hemoglobin,small amount),HCO3(major form,90%)
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Transport of CO2 as HCO3 to the lungs
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CO2 diffuses out of tissues into venous plasma & into RBC~in RBC(CO2+H20--H2CO3--H+HCO3);HCO3 leaves RBC(chloride shift)~HCO3 transp. to lungs & H+ is buffered by deoxyhemoglobin~in lungs, rxn. occur in reverse.
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Distributtion of pulmonary bld. flow in zone 2
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Art.press>alveolar press.>venous press.
-blood flow is medium;inc. of hydrostatic press. due to gravitational effects;bld. flow is driven by difference in pressure betw. alveolar & arterial |
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Right to left shunts
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Normally occur(2% of CO bypasses the lungs);may be as high 50% of CO(Tetralogy of Fallot)~dec. art. PO2 due to admixture of venous bld. to art. bld.
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Left to right shunts
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More common than right to left shunt;caused by congenital anomalies(patent ductus arteriosus) or traumatic injury;doesn't result in dec. art. PO2
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Effect of airway obstruction on V/Q ratio
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Vent. is zero;V/Q ratio is zero(if perfusion is normal);no gas exchange; PCO2 & PO2 of pulmonary capillary bld. approaches their values in mixed venous bld.
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Effects of bld. flow obstruction on V/Q ratio
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V/Q ratio is infinite(if vent. is normal);no gass exchange;PO2 & PCO2 of alveolar gas approaches their values in inspired air
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Distribution of pulmonary bld. flow in zone 3(base)
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Art.press>venous press.>alveolar press.
-blood flow is highest due to gravitational effects;bld. flow is driven betw. pressure of art. & venous;lowest V/Q~PO2 is lowest & PCO2 is highest bec. gas exchange is less efficient |
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Distribution of pulmonary bld flow due the effects of gravity in zone 1(apex)
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Alveolar press.>art.press>venous press.
-high alveolar press. compress the capillaries;dec. art. press. due to hemorrhage;inc. alveolar press. due to positve pressure ventilation;highest V/Q~PO2 is highest & PCO2 is lowest due to more efficient gas exchange |
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Function of the Dorsal resp. group of the Medullary resp. center located in the reticular form.
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Inspiration
-Vagus nerve inputs inf. from peripheral chemoreceptors & mechanoreceptors in the lung; Glossopharyngeal nerve inputs inf. from peripheral chemoreceptors;Phrenic nerve relays output signals to diaphram |
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Center resp. for expiration
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Ventral resp. group of the medullary resp. center in the reticular form.
-not active during normal ,quite breathing;active during exercise |
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Area of the brain w/c stimulates inspiration,producing a deep & prolonged inspiratory gasp(apneusis)
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Aneustic center
-located in lower pons |
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Area in the upper pons w/c inhibits inspiration~regulates inspiratory vol. & resp. rate
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Pneumotaxic center
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Area of the brain w/c can voluntarely control they're breathing(hyperventilate or hypoventilate)
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Cerebral Cortex
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Chemoreceptors & meconreceptors w/c help control breathing
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Central chemoreceptors of the medulla, peripheral chemoreceptors(carotid & aortic bodies),lung stretch receptors(Hering-Breuer reflex),irritant receptors,Juxtacapillary receptors(left heart failure),joint & muscle receptors(exercise)
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Function of the central chemoreceptors in the medulla
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Dec. in pH stimulates hyperventilation
-CO2(art. bld) diffuses into the CSF~ in CSF(CO2+H20--H2CO3--HCO3+H)~H+ acts directly on the central chemorecetor |
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Funct. of the carotid(located at the bifurcation of common caotid) & aortic bodies(located above & below the aortic arch) in control of breathing
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Inc. breathing when PO2 levels are <60mmHg,inc. art. PCO2,inc. in art. H+(carotid body) or dec. pH
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Respiratory response to exercise in regards to O2 consump.,CO2 prod.,vent. rate,art. PO2 & PCO2,art. pH,venous PCO2,pulmonary bld. flow,V/Q ratios
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O2 consump.(inc.),CO2 prod.(inc.), vent. rate(inc. to match O2 consump. & CO2 prod.),art. PO2 & PCO2(no change)
,art. pH(no change in mod. exercise, dec. in strenous exercise),venous PCO2(inc.),pulm. bld. flow(inc.),V/Q ratio(evenly distributed in the lung) |
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Adaptation to high altitude in regards to alveolar PO2,art. PO2,vent. rate, art. pH,hemoglobin conc.,2,3-DPG conc.,
hemoglobin-O2 curve,pulmonary vascular resistance |
Alveolar PO2(dec. due to dec. barometric press.),art.pH(hypoxemia), vent. rate(hypervent.),art. pH(respiratory alkalosis due to hyperventilation),hemoglobin conc.(polycythemia),2,3-DPG conc.(inc.), pulmonary vascular resistance(vasoconstriction due to hypoxemia~ hypertrophy of right vent.)
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