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30 Cards in this Set

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Where in the respiratory tree is cartilage present?
Cartilage - trachea and bronchi
How far into the respiratory tree do pseudostratified ciliated columnar cells extend? What about goblet cells?
Ciliated columnar until respiratory bronchioles

Goblet cells until terminal bronchioles
What indicates fetal lung maturity?
Fetal lung maturity = lecithin: sphingomyelin ratio > 2.0 in amniotic fluid
What role do type II cells play in the lungs?
Type II pneumocytes:
1. secrete surfactant
2. regenerate type I and II cells
Clara cells?
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.
What are lamellar bodies and where are they found?
Lamellar bodies are found in type II pneumocytes and they store surfactant.
Where do aspirations go?
Aspirations:
Upright --> lower R inferior lobe
Supine --> upper R inferior lobe
How do you know where the pulmonary arteries are relative to the bronchus?
RALS
R pulm artery is anterior
L pulm artery is superior
At what level do things cross the diaphragm?
"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)
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
What is surfactant?
Surfactant: dipalmitoyl phosphadidylcholine
What substances are produced in lung?
Lung production:
1. Surfactant
2. Prostaglandins
3. Histamine (bronchoconstriction)
4. ACE (inactivates bradykinin)
5. Kallikrein (activates bradykinin)
What is vital capacity?
Vital capacity = tidal volume + inspiratory reserve volume + expiratory reserve volume
What is the formula for physiologic dead space?
Dead space (Vd) = tidal volume x (PaCO2 - PeCO2) / PaCO2
What are the two forms of hemoglobin and what pushes it from one to another?
Taut - low O2 affinity

Relaxed - high O2 affinity

High Cl, H, CO2, 2,3-BPG and temp favor taut form
Methemoglobin?
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.
How do you treat cyanide poisoning?
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.
Carboxyhemoglobin?
Carboxyhemoglobin is hemoglobin bound to CO (greater affinity for hemoglobin) which causes a L shift of O2-hemoglobin curve.
Which substances are perfusion limited in the lung? Diffusion limited?
Perfusion limited:
- O2 (in normal health), CO2, N2O

Diffusion limited:
- O2 (emphysema, fibrosis), CO
What is the formula for diffusion and how do emphysema and fibrosis lower diffusion rate?
Diffusion Vgas = (A / T) x (P1 - P2)

A = area (lower in emphysema)
T = thickness (higher in fibrosis)
P1-P2 = difference in partial pressures
What defines pulmonary artery HTN?
Pulmonary artery HTN = > 25 mmHg
What causes primary pulmonary HTN?
1o Pulm HTN: inactivating mutation in BMPR2 gene that usually inhibits vasc SMC proliferation
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
How does O2 content, O2 sat and P(O2) change with decreased Hb?
Hb decrease causes:
Decreased O2 content
Normal O2 sat
Normal P(O2)
What is the alveolar gas equation and what can it tell you?
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)
Where in the lung is ventilation highest? Perfusion highest?
Ventilation and perfusion are both highest at the apex. However V/Q is 3.0 which isn't ideal (1 is ideal)
How does the body increase O2 in blood during exercise?
Exercise --> vasodilation at apex of lung --> V/Q comes closer to 1
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
What dissociates from Hb when O2 binds? How does relate to the "Haldane effect"
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"
What is the Bohr effect?
Bohr effect: H+ from tissue metabolism in periphery shifts curve to the R causing unloading of O2