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107 Cards in this Set

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  • Back
what level do pseudocolumnar ciliated cells extend to?
respiratory bronchioles
what level do goblet cells extend to in the respiratory tree?
terminal brochioles
what type of cell proliferates during lung damage?
type II - serve as precursors to type I cells and other type II cells
each bronchopulmonary segment has how many arteries?
2 arteries - bronchial and pulmonary
what do ateries in the lungs run with?
airways
how many lobes does the right lobe have?
left lobe?
right has 3 lobes
left has 2 lobes and lingula (homologue of right middle lobe)
which lung is more common site for inhaled foreign body? why?
right - less acute angle of right main stem bronchus
relation of the pulmonary artery to the mainstem bronchus at each lung?
RALS:
right - anterior; left - superior
at what level does the IVC perforate the diaphragm?
T8
at what level do the esophagus and vagus (2 trunks) perforate the diaphragm?
T10
what perforates the diaphragm at T12?
aorta (red), thoracic duct (white), azygous vein (blue)
external intercostals, scalene muscles, sternomastoids aid in what phase of breathing during exercise?
inspiration
rectus abdominis, internal and external obliques, transversus abdominis, internal intercostals aid in what phase of breathing during exercise?
expiration
renal excretion of what increases at high altitude?
bicarbonate - to compensate for respiratory alkalosis
what is the role of kallikrein?
activates bradykinin
collapsing pressure = ?
2xtension/radius
air in lung after maximal epiration?
residual volume
air that can still be breathed out after normal expiration
expiratory reserve volume
air that moves into lung with each quiet inspiration?
tidal volume
air in excess of tidal volume that moves into lung on maximum inspiration?
inspiratory reserve volume
vital capacity = ?
TV + IRV + ERV
functional residual capacity = ?
RV + ERV (volume in lungs after normal expiration)
inspiratory capacity = ?
IRV + TV
total lung capacity = ?
IRV + TV + ERV + RV
an increase in all factors (except pH) causes a shift of the O2-Hb curve which way?
right
a decrease in all factors (except pH) causes a shift of the O2-Hb curve which way?
left
what gases are perfusion limited?
O2 (normal health), CO2, N20
gas equilibrates early along the length of the capillary
for perfusion limited gases, how can diffusion be increased?
only if blood flow is increased
what gases are diffusion limited?
O2 (exercise, emphysema, fibrosis); CO
gas does not equilibrate by the time blood reaches the end of the capillary
V/Q = ? at apex of lung
V/Q = 3 - wasted ventilation
V/Q = ? at base of lung
0.6 - wasted perfusion
both ventilation and perfusion are greater in what part of lung?
base
what happens to the V/Q ratio with exercise? why?
approaches 1 - increased cardiac output & vasodilation of apical capillaries
organisms that thrie in high O2 (e.g. TB) flourish in what part of the lung?
apex
V/Q -> 0 in what?
airway obstruction/ shunt
V/Q -> infinity in what?
blood flow obstruction/ physiologic dead space
what is the Haldane effect?
in lungs, oxygenation of Hb promotes dissociation of CO2 from hemoglobin
what is the Bohr effect?
in peripheral tissue, increased H+ shifts curve to right, unloading O2
what are the four primary causes of decreased PO2 in arterial blood?
hypoventilation, diffusion impairment, shunt, V/Q mismatch
what is the normal alveolar-arterial O2 difference?
10 mmHg
decreased FEV1/FVC ratio?
obstructive lung disease
increased FEV1/FVC ratio?
restrictive lung disease
findings in chronic bronchitis?
wheezing, crackles, cyanosis
alpha 1 antitrypsin deficiency leads to increased activity of what?
elastase
findings in emphysema?
dyspnea, decreased breath sounds, tachycardia, decreased I/E ratio
Curschmann's spirals, smooth muscle hypertrophy, and mucous plugging are seen in what?
asthma
centriacinar emphysema
smoking
panacinar emphysema
alpha 1 antitrypsin deficiency
allele associated with alpha1 antitrypsin deficiency?
PiZZ
absent/decreased breath sounds over affected area; decreased resonance and fremitus, and tracheal deviation toward side of lesion?
bronchial obstruction
decreased breath sounds, dullness (resonance); decreased fremitus?
pleural effusion
bronchial breath sounds over lesion, dullness, increased fremitus?
pneumonia (lobar)
decreased breath sounds, hyperresonant, absent fremitus, trachea deviated away from side of lesion?
pneumothorax
in what type of lung disease are lung volumes greater than normal?
obstructive - increased TLC, FRC, and RV
in what type of lung disease are lung volumes less than normal?
restrictive
FEV1 is more dramatically reduced in what type of lung disease?
obstructive - results in decreased FEV1/FCV ratio
asbestosis increases risk for what?
pleural mesothelioma and bronchogenic carcinoma
asbestosis plus smoking greatly increase risk of what?
bronchogenic cancer (smoking not additive with mesothelioma)
asbestos fibers coated with hemosderin?
ferruginous bodies
after what week of gestation is surfactant made most abundantly?
35
lecithin-to-sphingomyelin ratio is usually less than what in neonatal RDS?
1.5
lung tumors that arise centrally?
squamous cell carcinoma; small cell carcinoma - both have clear link to smoking
lung tumors that arise peripherally?
adenocarcinoma (most common)
bronchioalveolar carcinoma (thought not to be related to smoking)
large cell carcinoma - undifferentiated
organisms causing bronchopneumonia?
s. aureus, H. flu, Klebsiella, S. pyogenes
organisms causing interstitial (atypical) pneumonia?
viruses (RSV, adenoviruses), mycoplasma, legionella, chlamydia
dffuse patchy inflammation localized to interstitial areas at alveolar walls; distribution involving one or more lobes
atypical/interstitial pneumonia
acute inflammatory infiltrates from bronchioles into adjacent alveoli; patchy distribution involving one or more lobes
bronchopneumonia
organism causing lobar pneumonia?
pneumococcus
intra-alveolar exudate - consolidation, may involve entire lung
lobar pneumonia
how do you relieve symptoms caused by hyperventilation?
breathe in and out of plastic bag
2-5 micrometer yeast with thin cell wall but no true capsule; Mississippi river valley
histoplasmosis
anemia does what to mixed venous PO2?
decreases it
lamellar bodies within macrophages in desquamative interstitial pneumonitis contain what?
surfactant
hemosiderin accumulates in pulmonary macrophages in what setting?
CHF - produces golden brown hemorrhages
phrenic nerve paralysis, suffocation, submersion, poliomyelitis, tetanus, rib fractures, and Pickwickian syndrome are causes of what?
hypoventilation of peripheral origin
when is hypoventilation of central origin most commonly seen?
morphine or barbiturate overdose
what lung volume is associated with a positive airway pressure?
total lung capacity
bacteriodes, fusobacterium, and peptococcus species are the most common anerobic organisms isolated from lung abscesses- where do they come from?
normal oral flora
Rx for CF?
N-acetylcysteine - thins mucous
damage to phrenic nerve causing abdominal wall to paradoxically move inward during inspiration is caused by what?
contraction of intercostal muscles during inspiration causes the diaphragm to be drawn upward and the abdominal wall to be drawn inward
PTH-rp is associated with what type of lulng cancer?
squamous cell carcinoma
types of bronchogenic carcinoma?
squamous cell and small cell
what does the lipoxygenase pathway yield?
leukotrienes
what is LTB4?
a chemotactic agent
what do LTC4, D4, and E4 function in?
bronchoconstriction, vasoconstriction, contraction of smooth muscle, and increased vascular permeability
what is the role of PGI2?
inhibits platelet aggregation and promotes vasodilation (Platelet-Gathering Inhibitor)
what effect do leukotrienes have?
increase bronchial tone
waht effect does prostacyclin (PGI) have?
decreases platelet aggregation and vascular, bronchial, and smooth muscle tone
what effect do prostaglandins have?
increase uterine tone and decrease vascular and bronchial tone
what effect does thromboxane have?
increases platelet aggregation, vascular tone, and bronchial tone
prostacyclin, prostaglandins, and thromboxane come from what pathway?
cyclooxygenase
use of salmeterol? adverse effects?
long-acting agent for asthma prophylaxis; tremor and arrhythmia
this drug likely causes bronchodilation by inhibiting phosphodiesterase, thereboy decreasing cAMP hydrolysis
theophylline (a methylxanthine)
why is the usage of theophylline limited?
narrow therapeutic index - cardiotoxicity and nephrotoxicity
this drug prevents release of mediators and is effective for the prophylaxis of asthma
cromolyn
what do corticosteroids like beclomethasone, prednisone do?
inhibit the synthesis of virtually all cytokines; inactivate NF-kB, the transcription factor that induces the production of TNF-alpha, etc.
this drug is a 5-lipoxygenase pathway inhibitor that blocks conversion of arachidonic acid to leukotrienes
zileuton
how do zafirlukast, montelukast work?
block leukotriene receptors
this drug causes a competitive b lock of muscarinic receptors, preventing bronchoconstriction
ipratropium
use and adverse effect of isoproterenol?
relaxes bronchial smooth muscle (B2)
tachycardia (B1)
is venous blood more acidic or basic than arterial blood?
more acidic - higher pCO2, which produces carbonic acid
lung volumes that cannot be measured with spirometry?
FRC, RV
NMDA receptor allows influx of what?
cations - sodium and calcium
cations entering the cell through ion channels produce what?
depolarization (anions produce hyperpolarization)
what factor is implicated in the pathogenesis of nasopharyngeal carcinoma/lymphoepithelioma?
EBV
treatment for PCP pneumonia?
TMP-SMX
the amount of CO2 blown off is inversely proportional to what?
alveolar ventilation