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139 Cards in this Set
- Front
- Back
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What are the functions of the airways? (8)
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1. Filtering - want to remove infiltrates
2. Warming - 37C through mucosal membrane (rich venous plexus) - when inhale there is a transfer of heat from blood to air and vice versa when exhale 3. Humidifying - otherwise membranes dry out (want 100% when reach alveoli) 4. Turbulent precipitation 5. Sneeze Reflex 6. Gag reflex - keep materials from entering trachea 7. Cough reflex - stimulate airways 8. Swallow reflex - skeletal and smooth muscle interaction |
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What makes up the lower respiratory tract?
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Larynx, trachea, tracheobronchial tree
(Everything below the glottis) |
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What two structures make up the larynx? Where are they located?
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1. Epiglottis - above glottis (part of upper respiratory tract)
2. Glottis - opening between vocal cords |
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What is the tracheobronchial tree?
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A series of branching tubes which become narrower, shorter and more numerous as they penetrate deeper into the lungs. This results in an increase in total cross-sectional area
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The trachea extends from the ____ to the _____.
What supports the trachea? |
Trachea to the carina
C-shaped cartilages |
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What are 3 common epithelial cell types and their functions?
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1. Ciliated cells - propel mucus blanket
2.Goblet cells - secrete mucus blanket 3. Basal cells - divide to replace cells Work together to form a mucociliary escalator |
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What type of epithelial cell can differentiate into other cell types?
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Basal cells
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Name the generation numbers that go along with the following:
Primary Bronchi Lobar Bronchi Segmental Bronchi Bronchioles Terminal Bronchioles |
Primary Bronchi - 1
Lobar Bronchi - 2 Segmental Bronchi - 3 Bronchioles - 4 through 16 Terminal Bronchioles - 16 |
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From where do the conducting airways extend?
What is in this area? |
From the nose to terminal bronchioles
Anatomical dead space |
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What generations consist of the respiratory bronchioles?
What buds off these bronchioles? What kind of zone is here? |
Generations 17-19
Have alveoli budding off Transitional zone - conducting gas exchange |
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What generations consist of the alveolar ducts?
What are they lined with? |
Generations 20-22
Completely lined with alveoli |
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The alveolar sacs are what generation?
What are they groups of? |
Generation 23
Groups of alveoli |
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As you go down the tracheobronchial tree, velocity ______ and total cross-sectional area _____.
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Velocity decreases
Total cross-sectional area increases |
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As you go deeper in the tracheobronchial tree towards the terminal bronchioles, there is an _____ in smooth muscle and a _____ in cartilage.
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Increase in smooth muscle
Decrease in cartilage |
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T/F:
Past the terminal bronchioles, all cartilage is lost. |
True
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What system regulates bronchomotor tone? Stimulation causes constriciton.
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Parasympathetic nervous system
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What kind of receptors do vagal fibers activate in the parasympathetic ganglia on and in the airway wall?
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Nicotinic receptors
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What kind of fibers release acetycholine and stimulate M3-muscarinic receptors on airway smooth muscle cells?
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Short postganglionic fibers
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The parasympathetic system also stimulates what kind of glands?
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Submucosal glands
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What two hormones cause dilation of the airways? (Mainly from the adrenal medullae/few sympathetic fibers)
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Epinephrine and norepinephrine
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What 3 types of agents can be used to treat bronchoconstriction?
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1. Anticholinergic agents (atropine, scopolamine)
2. Beta-2 adrenergic agnoists (albuterol, turbutaline) 3. Anti-inflammatory agents (glucocorticoids) |
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What can be used in the treatment of airway hypersecretion?
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Belladonna alkaloids inhibit secretion in nose, mouth, pharynx and bronchi
Atropine/Scopolamine used in preanesthetic medication - may have side effects in patients with airway disease |
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Alveoli
How many are there? How big are they? What is their surface area? Have a dense ______ bed. |
There are 2 to 6 (10^8) - average 300 million
0.25-0.33 mm in diameter 50 to 100 square meters (average 80) Have a dense capillary bed |
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Blood-gas Barrier
What is their average thickness? What 6 items make up this barrier? |
<0.5 micrometers
1. Surfactant - dipalmitoyl lecithin 2. Alveolar epithelium Type 1 pneumocytes - squamous cells Type 2 pneumocytes - not part of barrier but are more numerous 3. Interstitium - with basement membranes 4. Capillary endothelial cells 5. Plasma 6. Erythrocyte cell membrane |
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What are some defense mechanisms for the respiratory system? (11)
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1. Filtering
2. Turbulent precipitation 3. Sneeze reflex 4. Gag reflex 5. Cough reflex 6. Mucociliary escalator 7. Biochemical - immunoglobulins, interferons, antibodies 8. Settling 9. Phagocytosis - macrophage, PMNs 10. Lymphatic drainage 11. Lymphoid tissue - tonsils, adenoids, lymph nodes |
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What is the significance of respiratory diseases? (4)
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1. Respiratory infections - most frequent diseases
2. Lung cancer - a leading killer 3. Secondary to other diseases 4. Pollution |
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What are the 3 categories of respiratory diseases?
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1. Early cough diseases - those involving the mucosa or generating secretions; localized
2. Early dyspnea diseases - those that interfere with gas exchange; diffuse 3. Acute/Chronic |
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What are two chronic dyspnea diseases?
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Pneumoconioses and acute cough
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What causes pneumoconioses?
What does it damage? |
Caused by the inhalation of mineral or organic dust - silicosis, asbestosis
Damages exchange surfaces Sharp particles kill macrophages in alveoli leading to the development of bacteria |
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What are two types of acute cough diseases?
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Bacteria pneumonias and bronchopneumonia
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Bacteria pneumonias include what 3 bacteria?
What part of the lung is it involved in? |
Pneumococci, Klebsiella, Staphylococcal
Lobar - involvement of an entire lobe |
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What kind of people are most susceptibel to bacterial pneumonias?
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In debilitating people including those with AIDs, homeless people, and those on either long-term antibiotics or immunosuppresants
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What kind of involvement of the lung does bronchopneumonia have?
What does it usually follow? Who is it a threat to? What causes it? Are complications common or uncommon? |
Patchy areas of involvement
Usually follows bronchitis/bronchiolitis Threat mainly to the vulnerable Caused by an organism Complications common |
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T/F:
Bronchopneumonia is limited to the airways. |
True
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T/F:
Viral pneumonia is caused by bacteria and fungi. |
False
It is caused by: Mycoplasm pneumoniae Influenza types A and B Parainfluenza Respiratory syncytial virus (RSV) Some ECHO viruses Varicella type (adult chickenpox) |
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What is an example of a chronic cough disease?
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Bronchiectasis
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What is bronchiectasis?
What causes it? |
An abnormal dilation of the bronchi and larger bronchioles, associated with a chronic necrotizing infection.
Staphylococci, streptococci, pneumococci, enteric organisms |
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What percentage do bonchogenic carcinomas account for with regards to lung cancers?
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90-95%
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Squamous cell carcinoma:
What is it associated with? Where does it spread to? 4 times more common in men or women? 1 pack/day increases risk by how much for squamous cell carcinoma? |
Associated with smoking
Spreads outside thorax later to adrenal glands, brain and bone 4 times more common in men Increases risk 46 times |
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Adenocarcinoma:
Most in common in what population? Grows slower than what other type of carcinoma? Who is affected more, men or women? Where is this located? |
Most common in nonsmokers
Grows slower than squamous Men and women affected equally Located on periphery of bronchial tree outside of lungs |
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Small cell carcinoma:
Is it highly malignant or benign? What is it sensitive to? What is it strongly associated with? Can it be treated? |
High malignant
Sensitive to chemotherapy and irradiation Strongly associated with smoking Usually can treat if found early |
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Large (giant) cell carcinoma:
Poor or good prognosis? What happens early on? What is the survival rate? |
Poor prognosis
Tends to metastasize early Survival rate is about 9% |
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The lungs receive the entire output of the _____ heart.
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Right
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Pulmonary vascular resistance =
Ohm's Law = |
P(in) - P(out)/(Flow/Kg)
E/(I*R) |
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Mean arterial pressure =
Mean capillary pressure = Mean left atrial pressure = Pulmonary circulation is a ___ pressure system. |
Mean arterial pressure = 14 mmHg
Mean capillary pressure = 11 mmHg Mean left atrial pressure = 8 mmHg Low pressure system |
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T/F:
A tiny change in radius has a profound effect of resistance. |
True
R = h/r^4 |
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Left side:
_____ pressure Thicker or thinner ventricle wall? More or less muscular? When exercise, it becomes ______. |
High pressure
Thicker ventricle wall More muscular and massive When exercise it gets bigger |
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The Starling Equation:
Know the variables |
Kp = pulmonary capillary filtration coefficient (permeability)
Pc = capillary hydrostatic pressure (11 mmHg) Pi-t = tissue oncotic pressure Pt = tissue hydrostatic pressure (-8 mmHg) Pi-c = capillary oncotic pressure (27 mmHg) Kp is small in the lungs |
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Ventilation - Perfusion Matching:
Recruitment/Derecruitment |
Recruitment - dilating vessels that go to the part of the lung that's being ventilated the most
Derecruitment - constricting vessels that go to the parts of the lung that aren't being as well ventilated |
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Regional V/Q Differences:
What 2 differences? What factors does it depend on? (5) |
Ventilation and perfusion differences
Depends on position, lung volume, ventilatory rate, perfusion rate, oxygen content |
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Hypoxic pulmonary vasoconstriction:
What causes vascular smooth muscle to constrict, decreasing blood flow to alveoli with low oxygen content? |
Reduce alveolar PO2
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What are the 2 pulmonary blood supplies?
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1. Pulmonary - deoxygenated blood to the arteries
2. Bronchial arteries - to walls of conducting airways to supply oxygen and nourish the cells |
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What is an example of acute dyspnea?
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Pulmonary embolism: a blood clot lodged in the pulmonary circulation. Often secondary to trauma or phlebothrombosis.
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What is an example of chronic dyspnea?
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Pulmonary vascular sclerosis: vascular changes associated with pulmonary hypertension
Primary - produced by primary pulmonary hypertension Secondary - produced by secondary pulmonary hypertension (kyphoscoliosis, Pickwickian syndrome) |
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What are two important mechanisms in ventilatory movement?
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1. Upward and downward movement of diaphragm
2. Elevation and depression of rib cage |
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What are the major inspiratory muscles?
Accessory muscles? |
Diaphragm and external intercostals
Sternocleidomastoid, scalenus, and anterior serratus |
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What are the major expiratory muscles?
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Internal intercostals and muscles of the anterior abdominal wall (rectus abdominis, internal and external oblique muscles and transversus abdominis).
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What is tidal volume?
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Volume inspired or expired with each normal breath
About 500 ml |
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What is inspiratory reserve volume?
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Volume that can be inspired above the normal tidal volume
About 3000 ml |
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Expiratory reserve volume?
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Volume that can be forcefully expired after a normal tidal expiration
About 11 ml |
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What is residual volume?
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Volume remaining in lungs after the most forceful expiration.
About 1200 ml |
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What is inspiratory capacity?
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Volume that can be inspired from FRC.
About 3500 ml |
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T/F:
When you exhale a normal, unforced breath, you use expiratory muscles. |
False
Turn of inspiratory muscles |
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What is vital capacity?
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Maximum volume that can be expired following maximum filling of the lungs.
About 4600 ml |
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What is total lung capacity?
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Maximum volume to which the lungs can be expanded.
About 5800 ml |
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What is functional residual capactiy (FRC)?
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The volume of air in the lungs at the equilibrium position (no active muscle contraction) where the inward elastic recoil forces of the lungs exactly equals the outward elastic recoil forces of the chest wall (resting end-expiratory position).
About 2300 ml Pleural pressure = -4 mmHg |
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What is thoracic independent volume?
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The volume of the thoracic cavity without the lungs.
70% TLC About 4060 ml |
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What is minute respiratory volume?
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Total amount of new air moved into the respiratory system each minute.
Tidal volume * Respiratory Rate |
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What is minute alveolar ventilation?
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Rate at which new air reaches the gas exchange areas of the lungs.
(TV - dead space) * Respiratory volume |
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What are 3 types of acute dyspnea?
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Atelectasis
Pneumothorax Hydrothorax |
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What is atelectasis?
What are 3 causes/types of atelectasis? |
Collapse or loss of air from the alveoli
1. Absorption 2. Compression 3. Traumatic |
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What is pneumothorax?
What are 3 causes? |
The presence of air in the pleural space
Complicating (secondary, idiopathic, traumatic |
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What is hydrothorax?
What are 2 causes? |
The presence of water in the pleural space
Complicating (secondary) and idiopathic |
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What is compliance?
Typical value? What do compliance values equal? |
The ease with which the lungs can be expanded (expansibility). Expressed as the volume change in the lungs for each unit change in pleural pressure.
0.22 L/cm water Equals the slope of the curves |
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What factors decrease compliance?
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Increased left atrial pressure
Pulmonary edema Alveolar fibrosis Airway obstruction (The first 3 stiffen the walls of the alveoli) |
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What factors increase compliance?
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Emphysema
Surfactant |
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What factors are responsible for elastic recoil of the lungs?
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1. Tissue forces - elastin and collagen
2. Surface forces - intermolecular attraction within the liquid lining the alveolar walls |
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What is surfactant made of?
Very ___ surface tension. Surface tension ____ as surface area _____. |
Dipalmitoyl lecithin
Low surface tension Surface tension decreases as surface area decreases |
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What does the Law of Laplace state?
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Wall tension is proportional to the product of pressure and radius. There P is proportional to tension divided by radius.
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T/F:
Surfactant follows the Law of Laplace? |
False
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What two conditions result from a lack of surfactant and/or damage to type 2 pneumocytes?
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Fetal lung syndrome
Adult respiratory syndrome (shock lung) |
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What is transmural airway pressure (TAP)?
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The pressure that controls the caliber of the airways
Is equal to the pressure within airway minus pressure surrounding airway TAP = P(in) = P(out) |
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What occurs during inhalation to pleural pressure and TAP?
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Pleural pressure becomes more and more negative as lungs expand.
TAP increases, surrounding lung tissue pulls outward on airways and airways enlarge. |
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What occurs during exhalation to the pleural pressure and TAP?
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Pleural pressure becomes less negative (may become positive).
TAP decreases, airways become smaller and may collapse. |
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What is the maximum expiratory flow test?
As airways collapse, airway resistance ______ and air flow _______. |
Plots air flow (L/min) vs. lung volume (L)
As airways collapse, airway resistance increases and air flow decreases. |
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What are the regional differences in pleural pressure?
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Due to the weight of the lung
Pleural pressure gradient gradient of 0.25 cm water/cm vertical distance Under certain conditions, alveoli at the base of lungs are smaller |
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Fick's Law of Diffusion
What is Kd proportional to? Inversely proportional to? |
Proportional to the solubility of the gas and temperature.
Inversely proportional to distance (thickness of membrane), square root of molecular weight of molecule (size), viscosity of medium and the charge of diffusing molecule |
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What are the values of:
Atmospheric air water? Humidified air water? Alveolar air O2? Alveolar air CO2? |
Atmospheric air water - 3.7
Humidified air water - 47 mmHg Alveolar air O2 - 104 mmHg Alveolar air CO2 - 40 mmHg |
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What are the values of:
Expired air O2? Expired air CO2? |
Expired air O2 - 120 mmHg
Expired air CO2 - 27 mmHg |
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What are the values of:
Arterial blood O2? Arterial blood CO2? Arterial blood pH? |
Arterial blood O2 - 100 mmHg
Arterial blood CO2 - 40 mmHg Arterial blood pH - 7.4 |
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What are the values of:
Mixed venous blood O2? Mixed venous blood CO2? Mixed venous blood pH? |
Mixed venous blood O2 - 40 mmHg
Mixed venous blood CO2 - 46 mmHg Mixed venous blood pH - 7.36 |
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What are the values of:
Arterial blood O2 capacity? Arterial blood O2 content? Arterial blood hemoglobin saturation? |
Arterial blood O2 capacity - 20 ml/100ml
Arterial blood O2 content - 19.8 ml/100ml Arterial blood hemoglobin saturation - 97.5% |
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What are the values of:
Venous mixed blood O2 capacity? Venous mixed blood O2 content? Venous mixed blood hemoglobin saturation? |
Venous mixed blood O2 capacity - 20 ml/100ml
Venous mixed blood O2 content - 14.62 ml/100ml Venous mixed blood hemoglobin saturation - 72.5% |
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T/F
The solubility of oxygen in plasma is very small. |
True
About 0.003 ml/mmHg PO2/dl |
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Each hemoglobin molecule can bind ____ oxygen (or CO) molecules.
One gram of hemoglobin can combine with ___ ml of O2. |
Bind with four oxygen molecules
Can combine with 1.34 ml of O2 |
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What is the normal hemoglobin concentration?
Blood can carry about ___ ml/dl (__ vol %) of oxygen via hemoglobin. |
15 g/dl
20 ml/dl or 20 vol% |
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What is hemoglobin percent saturation?
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[(O2 content - O2 dissolved) x 100]/(O2 capacity)
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What are the normal hematocrit levels in men and women?
What is the normal RBC count? |
Male: 45-52%
Female: 37-48% RBC count: 4.2 - 5.9 x 10^6 mm3 (10^12 L) |
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Oxyhemoglobin Dissociation Curve:
At tissues, oxygen dissociates ____ from hemoglobin At the tissues, PO2 is ___ mmHg or less. |
Readily
40 mmHg |
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What is P50?
At 37C and pH 7.4, normal human blood has a P50 of ____ mmHg. |
The PO2 at which 50% of the hemoglobin is saturated under a stated set of conditions.
26.6 mmHg |
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P50:
Higher affinity means the dissociation curve shifts ____. Lower affinity means the dissociation curve shifts ____. |
Left
Right |
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The Bohr Effect:
The affinity of hemoglobin is strongly influenced by changes in what? At the tissues, what does CO2 diffuse into? |
pH
Diffuses into the plasma |
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Bohr Effect:
Most enters the RBCs and undergoes one of two reactions: |
1. CO2 + H2O <--> H2CO3 <--> H+ + HCO3-
(Carbonic Anhydrase) 2. CO2 + Hb <--> Carbamino compounds DeoxyHb can form more than OxyHb |
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The addition or removal of CO2 has a direct effect on?
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[H+]
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In the lungs, [H+] falls as CO2 is removed and the curve is shifted to the _____.
In the tissues, CO2 is added and [H+] is increased which shifts the curve to the _____. |
Left
Right |
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The Bohr Effect enhances ____ uptake in the lungs and ____ at the tissues.
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O2
Release |
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What factors shift the oxygen dissociation curve left?
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Decrease in PCO2, temperature, P50 and 2,3-DPG
Increase in pH and affinity of Hb for O2 |
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What factors shift the oxygen dissociation curve right?
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Increase in: CO2, [H+], temperature, P50, 2,3-DPG
Decrease in: pH and affinity of Hb for O2 |
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What are 3 ways CO2 may be transported in the blood?
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1. Physical solution
2. Bicarbonate 3. Carbamino compounds |
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CO2 carried in physical solution:
About ___ times more soluble than oxygen. ___ to ___% of total. How much can be carried per liter per mmHg CO2 at 37C? How much at a PCO2 of 46 mmHg? |
20
5-10% 0.6 ml 27.6 ml/L |
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CO2 carried as bicarbonate:
What percentage of total CO2? |
80-90%
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CO2 carried as carbamino compounds:
What percentage of total CO2? |
5-10%
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What other factors affect CO2 transport?
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2,3-DPG and Carbon monoxide
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2,3-DPG:
What is it produced by? High concentrations shift the curve to the ____. Low to the ____. |
Produced by RBCs during anaerobic glycolysis
High - right Low - left |
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T/F
Blood stored at blood banks become depleted of 2,3-DPG. |
True
O2 diffuses into bag and constantly reduces concentration of 2,3-DPG. This moves the curve to the left and increases the affinity for Hb, making it harder to unload oxygen to provide to the tissues. This dictates how long blood may be stored. |
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Carbon monoxide:
Has a much ____ affinity for Hb than does oxygen. What does it form? In what direction does it shift the curve? |
Much greater affinity
Forms carboxyhemoglobin (COHb) Shifts left - very severe shift |
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The Haldane Effect T/F:
The amount of oxygen bound to Hb has no affect on the amount of CO2 carried by Hb. |
False, it does have an affect - inverse relationship.
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Haldane Effect:
Enhances the elimination of ____ in the lungs and uptake at the tissues. |
CO2
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Henderson-Hasselbach Equation:
pH = pK + log ([HCO3-]/0.03PCO2 What is the pK, pH and normal concentration of HCO3-? |
pK = 6.1
pH = 7.4 Concentration = 24 mM/L |
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What 3 things control the regulation of ventilation?
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CO2, O2 and pH
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What mediates the control of ventilation?
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Chemoreceptors
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Where are central chemoreceptors located?
Do they cross the BBB? What do they liberate that stimulates chemoreceptors? What do they increase? |
Located on the ventral surface of the medulla
They cross the BBB easily Liberate H+ Increase ventilation |
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Where are peripheral chemoreceptors located?
What kind of signals do they send to the CNS? They are much ___ important than central receptors. |
Located in carotid and aortic bodies
Send afferent signals Much less important |
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What is the difference between hypoxia and hypoxemia?
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Hypoxia - a lack of adequate oxygen in the inspired air
Hypoxemia - insufficient oxygenation of the blood |
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If a person breathes a mixture adjusted to keep alveolar O2 constant, but CO2 is raised, ventilation is _____.
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Increased
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If a person breathes a mixture that keeps CO2 low, the alveolar PO2 can be reduced to about ___ mmHg before increased ventilation is stimulated.
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50 mmHg
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T/F:
In normal control of ventilation, PO2 comes into play only under extreme conditions. |
True
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O2 levels stimulate _____ chemoreceptors.
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Peripheral
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In a young fit adult, minute volume may increase ____ times above resting level. The exact cause for this is largely _____.
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15 times
Unknown |
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During exercise, arterial PCO2 does not ____, and may ____ slightly.
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Increase
Fall |
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During exercise, arterial PO2 usually ____ slightly in a fit individual.
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Increase
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Arterial pH remains fairly constant during ____ exercise, but falls during _____ exercise due to lactic acid production.
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Moderate
Heavy |
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What factors increase ventilation during increased activity?
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1. Proprioreceptors in muscles, joints and tendons
2. Stretch receptors in airways and chest walls 3. Learned response to exercise NOT arterial CO2, O2 and pH |
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An inflammatory disease characterized by hyperresponsiveness of the airways and episodic periods of bronchospasm. It is a complex disorder involving biochemical, autonomic, immunologic, infectious, endocrine, and psychologic factors in varying degrees in different individuals. Most attacks are short lived, with freedom from symptoms between episodes, although airway inflammation is present even when asymptomatic.
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Asthma
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Considered as a spectrum of diseases extending from chronic bronchitis on one end to emphysema on the other. Although both may occur as “pure” forms, in most cases, they coexist. Patients are classified as those with predominantly chronic bronchitis and those with predominantly emphysema.
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COPD
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Defined as hypersecretion of mucus and chronic productive cough that continues for at least 3 months of the year for at least 2 consecutive years. Incidence is increased in smokers (X20) and even more so in workers exposed to air pollution.
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Chronic bronchitis
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This disorder is defined by inflammation of the bronchi caused by irritants or infection. It can be acute or chronic and is characterized by mucous gland hyperplasia, muscle hypertrophy, bronchial wall thickening, and inflammation. These factors lead to obstruction of air flow.
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Bronchitis
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A systemic disease of infancy or childhood in which there is a fundamental defect in the secretory process of all forms of exocrine glands.
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Cystic fibrosis
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This disorder is an abnormal permanent enlargement of gas-exchange airways accompanied by destruction of alveolar walls and without obvious fibrosis.
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Emphysema
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