Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
129 Cards in this Set
- Front
- Back
|
What is the innervation of the abdominal muscles?
|
Lower thoracic and upper lumbar
|
|
|
What is the role of the accessory respiratory muscles?
|
Elevate and splay the ribs
|
|
|
What variables of respiration can be changed by the CNS?
|
Frequency of breaths (rhythm)
Tidal volume |
|
|
What part of the medulla will lead to respiratory arrest if lesioned?
|
Pre-Botzinger complex
|
|
|
What is the difference between tachypnea and hyperpnea?
|
Tachypnea = increase in frequency
Hyperpnea = increase in depth (tidal volume) and frequency |
|
|
Accessory respiratory muscles are usually employed in what type of breathing?
|
Dyspnea
|
|
|
Cheyenne Stokes respiration can be caused by what two things?
|
CHF
Lesion to forebrain |
|
|
What is the pattern of Cheyenne Stokes respiration?
|
Weak respiratory breaths --> apnea --> hyperpnea
|
|
|
A lesion to the pontine parabrachial area (pontine pneumotaxic center) can cause what type of breathing?
|
Apneusis
|
|
|
Ataxic breathing can be caused by lesion to what part of the brainstem?
|
Medulla reticular formation (stroke or trauma)
|
|
|
What is the pattern of breathing in apneusis?
|
Prolonged inspiration and short expiration
|
|
|
What is the pattern of ataxic breathing?
|
Irregular breathing followed by increased periods of apnea
|
|
|
Hyperventilation can be caused by a lesion to what part of the brainstem?
|
Pontine reticular formation
|
|
|
The laryngeal muscles are innervated by ___ while the pharyngeal muscles are innervated by ___
|
Vagus; vagus and glossopharyngeal
|
|
|
Which class of drugs can also induce Cheyenne Stokes respiration?
|
Opiods
|
|
|
What are the two types of chemoreceptors
|
Central and peripheral
|
|
|
The carotid bodies send impulses via CN ___ and aortic bodies send impulses via CN ___.
|
Carotid bodies = CN IX
Aortic bodies = CN X --> NTS |
|
|
What are the three main pulmonary defense mechanisms?
|
Impaction
Sedimentation Diffusion |
|
|
What is the major mechanism for removal of material trapped in airways?
|
Cough
|
|
|
What value for FSI will indicate lung maturity?
|
Greater than 0.47
|
|
|
What lamellar body count will indicate lung maturity?
|
Greater than 35,000/ ul
|
|
|
What value for fluorescence polarization will indicate lung maturity?
|
Greater than 55 mg/g albumin
|
|
|
What value of L/S indicates lung maturity?
|
2.0-2.5
|
|
|
What does a L/S ratio of less than 1.5 mean?
|
Lung immaturity
|
|
|
What does a L/S ratio of 1.5-1.9 mean?
|
Transitional between immaturity and maturity
|
|
|
When is the phosphotidylglycerol test for lung maturity especially useful?
|
When amniotic fluid is contaminated with blood or meconium
|
|
|
FEV1 is normally how much of FVC?
|
80%
|
|
|
Does anatomic dead space refer to respiratory parenchyma or the conducting zone?
|
Conducting zone
|
|
|
What gradient is a useful measurement of whether or not there is sufficient delivery of gas?
|
A-a gradient
|
|
|
What four gases are found in alveoli?
|
Oxygen, carbon dioxide, nitrogen, water
|
|
|
True or false: conducting zone volume stays fairly constant while respiratory parenchyma changes with depth of breathing.
|
True
|
|
|
How much is anatomic dead space per kg?
|
~2ml/kg
|
|
|
Mechanical ventilation increases conducting zone volume or respiratory parenchyma volume?
|
Conducting zone volume
|
|
|
What is the relationship between transit time of alveolar capillary and arteries during exercise?
|
Transit time decreases
|
|
|
For an ideal lung, what is the ventilation/perfusion ratio?
|
Approx. 1.0
|
|
|
Why are noble gases useful in measuring RV and FRC?
|
They are insoluble in the lungs
|
|
|
COPD is most often associated with what?
|
Smoking
|
|
|
What is the clinical definition of chronic bronchitis?
|
Coughing daily for at least 3 months in at least 2 consecutive years
|
|
|
Which category of emphysema is mostly associated with spontaneous pneumothorax?
|
Distal acinar emphysema
|
|
|
Which type of emphysema usually occurs near foci of scarring?
|
Irregular emphysema
|
|
|
Bullae can be found in which type of emphysema?
|
Any type
|
|
|
How much of lung parenchyma is lost before symptoms are shown in emphysema?
|
1/3 of lung parenchyma
|
|
|
"Pink puffer" is seen in ___ while "blue bloaters" are seen in ___
|
Pink puffer = emphysema
Blue bloater = emphysema and chronic bronchitis |
|
|
Which transcription factor is found to be diminished in asthma?
|
T-bet
|
|
|
What is the role of transcription factor T-bet?
|
TH1 cell differentiation; IFN-gamma formation
|
|
|
What is the difference in the inflammatory infiltrate in asthma vs. chronic bronchitis?
|
Both have lymphocytes but asthma also has eosinophils while chronic bronchitis also has neutrophils
|
|
|
What is the most common form of extrinsic asthma reaction?
|
Atopic asthma
|
|
|
IL-4 secreted by TH2 cells lead to the production of what?
|
IgE
|
|
|
TH2 cells secrete IL-3, IL-5, GM CSF to trigger what?
|
Eosinophil recruitment
|
|
|
What do Curschmann spirals consist of?
|
Shed epithelium
|
|
|
What are Charcot-Leyden crystals composed of?
|
Eosinophils proteins
|
|
|
Is non-necrotizing or necrotizing inflammation found in bronchiectasis?
|
Necrotizing
|
|
|
What are the different shapes of dilatation seen in bronchiectasis?
|
Saccular
Fusiform Cylindroid (uniform throughout) |
|
|
What is the main muscle of inspiration?
|
Diaphragm
|
|
|
Most of the work of breathing is to counteract which type of resistance?
|
Static lung resistance
|
|
|
Volume dependent constraints are most similar between normal patients and obstructive or restrictive diseases?
|
Restrictive
|
|
|
What three classes of drugs most commonly cause drug-induced asthma?
|
1. aspirin
2. NSAIDs 3. Beta blockers |
|
|
What is the clinical mainstay of diagnosing asthma?
|
Spirometry -- look at FEV1/FVC thresholds
Also use PFT to look at TLC and RV as supporting data |
|
|
What drug is used to evaluate hyper responsiveness in asthma?
|
Methacholine -- smaller dose elicits hyper responsiveness = more severe
|
|
|
What comprises the Samter triad?
|
Asthma, aspirin or other NSAID allergy, nasal polyps
|
|
|
Which class of drugs is a first-line treatment for persistent asthma?
|
Corticosteroids
|
|
|
What are some side effects of inhaled corticosteroids for treatment of asthma?
|
Candidasis (oral thrush)
Respiratory infections Adrenal suppression |
|
|
How are leukotriene modifiers usually used in the treatment of asthma?
|
Secondary or add-on anti-inflammatory controllers for persistant asthma
|
|
|
Pulmonary wedge pressure is a measure of pulmonary venous or pulmonary arterial pressure?
|
Pulmonary venous = LA filling pressure = LV preload
|
|
|
What does the vascular waterfall model illustrate?
|
Blood flow is greatest at the base of the lung compared to the apex
|
|
|
What are dependent lung zones?
|
Areas of the lungs that are lowest in gravitational field
|
|
|
The work of breathing has to overcome what three forces?
|
Static lung resistance
Dynamic lung resistance Tissue viscous drag |
|
|
Dynamic lung resistance increases with what type of disorders?
|
Obstructive lung disorders
|
|
|
In an FRC maneuver, how does obstructive disorder differ from normal patient in terms of shape of curve?
|
Lower flow rate
Effort independent zone can be concave Higher TLC, higher RV |
|
|
What is physiological shunt in terms of V/Q ratio?
|
When there is poor ventilation and there is low oxygen in the pulmonary veins
|
|
|
What is physiological dead space in terms of V/Q ratio?
|
When there is excessive ventilation compared to low perfusion (of tissues, etc) so there is increased oxygen in pulmonary vein
|
|
|
What is acute hypoxic pressure response?
|
When pulmonary arterioles constrict in response to hypoxia in alveoli. Increases pressure of pulmonary artery
|
|
|
What is the purpose of acute hypoxic pressor response?
|
Minimize arterial hypoxemia for entire lung--diverts perfusion to better ventilated areas (V/Q matching)
|
|
|
Normal lung ventilation occurs between what values of V/Q?
|
0.10 < V/Q < 10
|
|
|
What factors increase the production of surfactant? Decreases?
|
Increase = glucocorticoids, TSH, Thyroid hormone
Decrease = androgens, insulin |
|
|
Aerobic capacity is a very powerful predictor of what?
|
Life expectancy and mortality
|
|
|
What are some measures of aerobic capacity?
|
VO2 peak
VO2 max Metabolic capacity |
|
|
What does 1 MET equal?
|
3.5 mL O2/kg/min
|
|
|
What is the relationship of rate of cardiac output with age and aerobic training?
|
Increase aerobic training = increase rate
Age = decrease rate |
|
|
What does the harmonic mean estimate?
|
Thickness of septal barrier through which diffusion occurs
|
|
|
What are some examples that would cause increase in harmonic mean (septal barrier thickness)?
|
Edema
Fibrosis |
|
|
Oxygen is a ___ limited gas in healthy lungs, but in diseased lung it usually becomes ___ limited.
|
Perfusion
Diffusion |
|
|
A Qs/QT ratio (shunt fraction) greater than what percent is incompatible with life?
|
50%
Can treat using PEEP (of at least 5mmHg H2O) |
|
|
Which part of the brain is responsible for generating respiratory rhythm?
|
Medulla
|
|
|
What is eupnea?
|
Normal breathing
|
|
|
What are the two centers in the medulla responsible for integrating and coordinating breathing?
|
Ventral respiratory column
Dorsal respiratory column |
|
|
The ventral respiratory column is responsible mainly for ___ while dorsal respiratory column is mainly responsible for ___.
|
VRC = expiration
DRC = inspiration |
|
|
Where is the dorsal respiratory column located?
|
Part of nucleus solitarius
|
|
|
What do central chemoreceptors respond to?
|
Changes in pH
|
|
|
What are the three subtypes of receptors associated with the tracheobronchial tree?
|
SARs (slowly adapting pulmonary stretch receptors)
RARs (rapidly adapting pulmonary receptors) Tracheobronchial C-fibers |
|
|
Which cranial nerve is associated with lower airway receptors?
|
Vagus
|
|
|
What is the difference between SARs, RARs and tracheobronchial C fibers in terms of myelination?
|
C fibers are unmyelinated
|
|
|
What respiratory changes are induced by SAR, RAR and C-fibers?
|
SARs--inhibit respiration
RARs--hyperpnea C-fibers--apnea |
|
|
Where is SAR and RAR located?
|
SAR--airway smooth muscle
RAR--respiratory epithelium |
|
|
When does periodic breathing usually occur?
|
During sleep
|
|
|
When is periodic breathing normal?
|
Premature babies -- REM and non-REM
Infants -- REM |
|
|
What is the difference between distal acinar emphysema and panacinar emphysema in location?
|
Distal = near visceral pleura and septa
Panacinar emphysema = distal alveoli/airways |
|
|
How do panacinar and centriacinar emphysema differ in which lobes are affected?
|
Panacinar = lower lobe
Centriacinar = upper lobe |
|
|
Which disease is the Reid index useful?
|
Chronic bronchitis
|
|
|
In simple chronic bronchitis there is evidence of obstruction in the PFT. True or false.
|
False--see in obstructive chronic bronchitis
|
|
|
Increased goblet cells is seen in which chronic disease?
|
Chronic bronchitis
|
|
|
In simple chronic bronchitis, where is the lesion? Obstructive chronic bronchitis?
|
Simple = Respiratory bronchioles
Obstructive = superimposed emphysema |
|
|
Clubbing of fingers can be seen with which two lung diseases?
|
Bronchietasis
Cystic fibrosis |
|
|
What lymphocytes are found in asthma vs bronchitis?
|
Asthma = CD4
Bronchitis = CD8 |
|
|
What serum antitrypsin level is indicative of homozygous deficiency of the protein?
|
Less than 15%
|
|
|
What is the second leading factor of COPD?
|
Bronchial hyper responsiveness
|
|
|
What does Hoover's sign signify?
|
Diaphragm flattening
|
|
|
Allergic bronchopulmonary aspergillosis can be associated with which three lung disorders?
|
Asthma
Bronchiectasis Cystic fibrosis |
|
|
Bronchial dilation is seen in which disease?
|
Bronchiectasis
|
|
|
Ciliary dyskinesia and cystic fibrosis can be predispositions to which lung disease?
|
Bronchiectasis
|
|
|
What are some factors that underlie asthma?
|
Genetic predisposition to type 1 hypersensitivity
Bronchial hyper responsiveness Airway inflammation |
|
|
Why is TH2 bad in asthma?
|
Promotes formation of IgE and allergic inflammation, making asthma worse
|
|
|
What is the role of T-bet?
|
Th1 differentiation and IFN gamma formation (inhibits TH2)
|
|
|
What group of white blood cells play a role in sustaining an inflammatory response in asthma without antigen exposure?
|
Eosinophils
|
|
|
When does the early phase of asthma occur? Late phase?
|
Early 30-60 minutes after exposure to antigen
Late = 4-8 hours after exposure to antigen |
|
|
What is the difference between extrinsic and intrinsic asthma?
|
Intrinsic caused by nonimmune triggers like viral infections, aspirin
|
|
|
Leukotrienes have what affect on lungs?
|
Bronchoconstriction
|
|
|
What two therapies for COPD are shown to increase survival?
|
Quit smoking
Long term oxygen therapy |
|
|
What is the inheritance pattern of CF?
|
Autosomal recessive
|
|
|
Newborn screening for CF tests for which pancreatic enzyme?
|
Immunoreactive trypsinogen
|
|
|
Lung infections by which organisms are most commonly seen in CF?
|
H. influenzae, P. aeruginosa, S. aureus
|
|
|
What is the most atypical organism to infect CF?
|
M. avium and M. abscessus
|
|
|
How do you diagnose Aspergillus fumigatus?
|
IgE >1000 IU/ml
|
|
|
Distal intestinal obstruction syndrome is usually a complication of what disease?
|
Cystic fibrosis, especially if inadequate replacement enzymes or poor treatment compliance
|
|
|
What are some signs of diabetes associated with CF?
|
Glucosuria and poor growth
|
|
|
Pattern of breathing is due to ___ while rhythm is due to ___
|
Pattern = motor neurons
Rhythm = medulla |
|
|
Which center is an important "off switch" for spontaneous inspiration?
|
Pontine pneumotaxic center
|
|
|
What is an example of periodic breathing?
|
Cheyenne Stokes breathing
|
|
|
Which type of emphysema is associated with spontaneous pneumothorax?
|
Distal acinar emphysema
|
