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