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30 Cards in this Set
- Front
- Back
- 3rd side (hint)
Where in the respiratory tree is cartilage present?
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Cartilage - trachea and bronchi
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How far into the respiratory tree do pseudostratified ciliated columnar cells extend? What about goblet cells?
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Ciliated columnar until respiratory bronchioles
Goblet cells until terminal bronchioles |
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What indicates fetal lung maturity?
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Fetal lung maturity = lecithin: sphingomyelin ratio > 2.0 in amniotic fluid
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What role do type II cells play in the lungs?
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Type II pneumocytes:
1. secrete surfactant 2. regenerate type I and II cells |
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Clara cells?
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Clara cells in lungs are non-ciliated, columnar cells that (1) secrete a component of surfactant (mainly it come from type II pneumos) and (2) degrade toxins.
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What are lamellar bodies and where are they found?
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Lamellar bodies are found in type II pneumocytes and they store surfactant.
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Where do aspirations go?
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Aspirations:
Upright --> lower R inferior lobe Supine --> upper R inferior lobe |
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How do you know where the pulmonary arteries are relative to the bronchus?
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RALS
R pulm artery is anterior L pulm artery is superior |
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At what level do things cross the diaphragm?
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"I (IVC) ate (T8) ten (T10) eggs (esophagus) at (aorta) twelve (T12).
Vagus with esophagus at T10 Red white and blue at T12: red (aorta) white (thoracic duct) and blue (azygos vein) |
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What is responsible for inspiration and expiration during quiet breathing?
Exercise? |
Quiet breathing:
In: diaphragm Exp: passive |
Exercise:
In: EXTernal intercostals, scalene muscles and sternomastoids Exp: rectus abdominis, INTernal intercostals, obliques, transversus abdominus |
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What is surfactant?
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Surfactant: dipalmitoyl phosphadidylcholine
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What substances are produced in lung?
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Lung production:
1. Surfactant 2. Prostaglandins 3. Histamine (bronchoconstriction) 4. ACE (inactivates bradykinin) 5. Kallikrein (activates bradykinin) |
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What is vital capacity?
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Vital capacity = tidal volume + inspiratory reserve volume + expiratory reserve volume
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What is the formula for physiologic dead space?
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Dead space (Vd) = tidal volume x (PaCO2 - PeCO2) / PaCO2
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What are the two forms of hemoglobin and what pushes it from one to another?
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Taut - low O2 affinity
Relaxed - high O2 affinity High Cl, H, CO2, 2,3-BPG and temp favor taut form |
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Methemoglobin?
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Methemoglobin is oxidized form of hemoglobin (Fe3+) and does not bind O2 well. It binds CN- very well though. It can be treated with methylene blue.
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How do you treat cyanide poisoning?
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To Tx cyanide poisoning, induce methemoglobin by giving nitrites (oxidizing hemoglobin). Methemoglobin then binds CN-, allowing cytochrome oxidase to function. Then give thiosulfate to bind cyanide to form thiocyanate, which is renally excreted.
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Carboxyhemoglobin?
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Carboxyhemoglobin is hemoglobin bound to CO (greater affinity for hemoglobin) which causes a L shift of O2-hemoglobin curve.
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Which substances are perfusion limited in the lung? Diffusion limited?
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Perfusion limited:
- O2 (in normal health), CO2, N2O Diffusion limited: - O2 (emphysema, fibrosis), CO |
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What is the formula for diffusion and how do emphysema and fibrosis lower diffusion rate?
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Diffusion Vgas = (A / T) x (P1 - P2)
A = area (lower in emphysema) T = thickness (higher in fibrosis) P1-P2 = difference in partial pressures |
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What defines pulmonary artery HTN?
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Pulmonary artery HTN = > 25 mmHg
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What causes primary pulmonary HTN?
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1o Pulm HTN: inactivating mutation in BMPR2 gene that usually inhibits vasc SMC proliferation
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How do each of the following cause pulm HTN (there are many other causes)
- COPD - recurrent thromboemboli - L--> R shunt - high altitude or sleep apnea |
COPD: destruction of lung parenchyma
Reccurent thromboemboli: decreased cross-sectional area of pulm vascular bed |
L--> R shunt: stress--> endothelial injury
Sleep apnea or high altitude: hypoxic vasoconstriction |
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How does O2 content, O2 sat and P(O2) change with decreased Hb?
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Hb decrease causes:
Decreased O2 content Normal O2 sat Normal P(O2) |
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What is the alveolar gas equation and what can it tell you?
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PA(O2) = 150 - Pa(O2) / 0.8 and if you subtract the arterial O2 content, the A-a gradient should normally be between 10-15 mm Hg
Higher A-a gradients indicate hypoxemia (e.g. shunting, V/Q mismatch, fibrosis) |
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Where in the lung is ventilation highest? Perfusion highest?
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Ventilation and perfusion are both highest at the apex. However V/Q is 3.0 which isn't ideal (1 is ideal)
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How does the body increase O2 in blood during exercise?
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Exercise --> vasodilation at apex of lung --> V/Q comes closer to 1
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V/Q = 0 ?
V/Q = infinity In which situation will 100% oxygen help? |
V/Q = 0 is airway obstruction (shunt)
V/Q = infinity is blood flow obstruction (increased physiologic dead space) Assuming not blood flow isn't fully blocked, 100% oxygen helps improve V/Q = infinity |
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What dissociates from Hb when O2 binds? How does relate to the "Haldane effect"
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Hb binds and H+ dissociates more rapidly. The H+ then shifts equilibrium towards CO2 formation (combining with HCO3-). CO2 release from RBC is called the "Haldane effect"
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What is the Bohr effect?
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Bohr effect: H+ from tissue metabolism in periphery shifts curve to the R causing unloading of O2
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