Usmle First Aid Respiratory

Front 1

Which six structures make up the conducting zone of the respiratory tree?

Back 1

The nose, the pharynx, the trachea, the bronchi, the bronchioles, and the terminal bronchioles

Front 2

True or False: One of the functions of the conducting zone of the lungs is to warm and humidify air.

Back 2

true; the conducting zone also filters air

Front 3

What type of muscle is found in the walls of the conducting airways in the anatomic dead space?

Back 3

smooth muscle

Front 4

The area of the lungs that participates in gas exchange is also called the respiratory zone. What anatomic areas does it encompass?

Back 4

The respiratory bronchioles, the alveolar ducts, and the alveoli

Front 5

Cartilage is present only in what two components of the respiratory tree?

Back 5

Trachea and bronchi

Front 6

Which zone of the respiratory tree includes the anatomic dead space?

Back 6

The conducting zone

Front 7

Goblet cells extend to the _____ (respiratory/terminal) bronchioles, while pseudostratified ciliated cells extend to the _____ (repiratory/terminal) bronchioles.

Back 7

terminal; respiratory

Front 8

What type of pneumocyte makes up 97% of alveolar surfaces?

Back 8

Type I pneumocytes

Front 9

What type of pneumocyte makes up just 3% of pneumocytes?

Back 9

Type II pneumocytes

Front 10

What are two important functions of type II pneumocytes?

Back 10

To secrete surfactant and to serve as precursors to pneumocytes (both types I and II)

Front 11

What is dipalmitoyl phosphatidylcholine?

Back 11

Surfactant

Front 12

What is the function of surfactant?

Back 12

To decrease alveolar surface tension

Front 13

Which cells proliferate to repair the lungs after they have been damaged?

Back 13

Type II pneumocytes

Front 14

What is the fate of mucus secreted within the respiratory tract?

Back 14

It gets swept out of the lungs and toward the mouth

Front 15

What feature of the pseudocolumnar cells of the respiratory tract allow them to move mucus toward the mouth?

Back 15

cilia

Front 16

What ratio of concentrations of which two molecules in amniotic fluid can be used as a marker of fetal lung maturity?

Back 16

The lecithin-to-sphingomyelin ratio
(> 2 implies maturity of the lungs)

Front 17

Where is the lecithin-to-sphingomyelin ratio measured to assess fetal lung maturity?

Back 17

amniotic fluid

Front 18

A lecithin-to-sphingomyelin ratio with what value is indicative of fetal lung maturity?

Back 18

>2.0

Front 19

Histologically, while type I pneumocytes are _____ (cuboidal/squamous), type II pneumocytes are _____ (cuboidal/squamous).

Back 19

Squamous; cuboidal
(type one must be thin so that gas exchange can occur across them)

Front 20

What is the advantage of having thin squamous cells that line the alveoli?

Back 20

They allow for optimal gas diffusion

Front 21

What are clara cells?

Back 21

Nonciliated columnar pneumocytes with secretory granules

Front 22

What are three functions of clara cells?

Back 22

They secrete a component of surfactant, degrade toxins, and act as reserve cells

Front 23

Which cells are responsible for clearing debris that accumulates in the alveoli?

Back 23

Macrophages

Front 24

In pulmonary gas exchange, _____ (carbon dioxide/oxygen) diffuses from the capillary lumen to the alveolar space, while _____ (carbon dioxide/oxygen) diffuses from the alveolar space to the capillary lumen.

Back 24

Carbon dioxide; oxygen

Front 25

In the lung, the endothelial cells are connected by _____ _____.

Back 25

Tight junctions

Front 26

Surfactant is secreted from the lamellar bodies of ____ (type I/type II/clara cell) pneumocytes.

Back 26

Type II

Front 27

What is the function of surfactant?

Back 27

To decrease alveolar surface tension

Front 28

An oxygen molecule is in the alveolus. In order, what cells will it cross to be able to bind to heme in the RBCs?

Back 28

To pass through the alveolar space to the capillary lumen, oxygen diffuses across the type I pneumocyte and then the endothelial cell

Front 29

To pass through the alveolar space to the capillary lumen, oxygen diffuses across the type I pneumocyte and then the endothelial cell

Back 29

The majority of carbon dioxide will exit the RBC as bicarbonate (in exchange for chloride), cross the endothelial cell, then the type I pneumocyte to enter the alveolar space

Front 30

Along with pneumocytes, which phagocytic cells can be found in the alveolar space?

Back 30

macrophages

Front 31

Each bronchopulmonary segment has what three structures in the center?

Back 31

A tertiary bronchus and two arteries; remember the mnemonic: Arteries run with Airways

Front 32

What is another name for a tertiary bronchus?

Back 32

A segmental bronchus

Front 33

What two arteries are found in the center of each bronchopulmonary segment?

Back 33

A bronchial artery and a pulmonary artery

Front 34

What two structures are found along the borders of each bronchopulmonary segment?

Back 34

Veins and lymphatics

Front 35

Pulmonary _____ (arteries/veins) carry _____ (deoxygenated/oxygenated) blood from the right side of the heart to the lungs.

Back 35

Arteries; deoxygenated

Front 36

True or False: Pulmonary arterial pressure fluctuates depending on the stage of the cardiac cycle.

Back 36

False; elastic walls maintain relatively constant pulmonary arterial pressures during the entirety of the cardiac cycle

Front 37

How many lobes does the right lung have?

Back 37

Three

Front 38

How many lobes does the left lung have?

Back 38

two

Front 39

What structure does the left lung have that the right lung does not?

Back 39

A lingula; remember the mnemonic: Left has the Lingula

Front 40

Why is the right lung a more common site for an inhaled foreign body?

Back 40

The right main stem bronchus is wider and more vertical than the left one

Front 41

The left lung lacks what lobe?

Back 41

The middle lobe

Front 42

Instead of a middle lobe, the left lung has a space that is occupied by what?

Back 42

the heart

Front 43

Where is the pulmonary artery in relation to the bronchus within the right lung hilus?

Back 43

anterior (RALS- right anterior, left superior)

Front 44

Where is the pulmonary artery in relation to the bronchus within the left lung hilus?

Back 44

Superior

Front 45

In the right lung, the _____ (horizontal/oblique) fissure divides the superior lobe and the middle lobe.

Back 45

horizontal

Front 46

In the anterior aspect of the right lung, the oblique fissure divides which two lobes?

Back 46

The middle and the inferior lobes

Front 47

In the anterior aspect of the left lung, the oblique fissure divides which two lobes?

Back 47

The superior and the inferior lobes

Front 48

The horizontal fissure of the right lung is at the level of the _____ rib.

Back 48

Fourth

Front 49

In the posterior aspect of both the right and left lungs, the _____ (horizontal/oblique) fissure divides the superior and inferior lobes.

Back 49

oblique

Front 50

In the posterior aspect of the right and left lungs, the medial aspect of the oblique fissure is at the level of which vertebra?

Back 50

T2

Front 51

While both the right and left lungs have a(n) _____ (oblique/horizontal) fissure, only the right lung has a(n) _____ (oblique/horizontal) fissure.

Back 51

Oblique; horizontal

Front 52

A 5-year-old male presents after having aspirated a peanut while lying in bed. The peanut has most likely lodged in the _____ (lower/superior) portion of the (left/right) _____ (inferior/superior) _____ lobe.

Back 52

Superior; right; inferior

Front 53

A 33-year-old male presents after having aspirated a steak tip while sitting at the dinner table. The steak tip has most likely lodged in the (lower/superior) portion of the (left/right) (inferior/superior) lobe.

Back 53

Lower; right; inferior

Front 54

At what level does the inferior vena cava perforate the diaphragm?

Back 54

T8; remember the mnemonic: T8: vena cava (8 letters in vena cava)

Front 55

What two structures perforate the diaphragm at the level of T10?

Back 55

The esophagus and the vagus

Front 56

At what level does the esophagus perforate the diaphragm?

Back 56

T10; remember the mnemonic: T10: (o)esophagus [10 letters in (o)esophagus]

Front 57

At what level do the two trunks of the vagus perforate the diaphragm?

Back 57

T10

Front 58

What three structures perforate the diaphragm at the level of T12?

Back 58

The aorta, thoracic duct, and azygos vein; remember the mnemonic: T12: aortic hiatus (12 letters in aortic hiatus)

Front 59

At what vertebral level does the aorta perforate the diaphragm?

Back 59

T12

Front 60

At what vertebral level does the thoracic duct perforate the diaphragm?

Back 60

T12

Front 61

At what vertebral level does the azygous vein perforate the diaphragm?

Back 61

T12

Front 62

Neurons from vertebral levels _____, _____, and _____ come together to form the phrenic nerve, which innervates the diaphragm.

Back 62

C3, C4, and C5; remember the mnemonic: "C3, 4, 5 keeps the diaphragm alive"

Front 63

Pain from the diaphragm can be referred to which anatomic region?

Back 63

shoulder

Front 64

Which tendon can be found on the inferior aspect of the diaphragm surrounding the caval and esophageal hiatuses?

Back 64

The central tendon

Front 65

What mnemonic can be used to recall the levels at which certain anatomic structures perforate the diaphragm relates?

Back 65

"I (IVC) ate (8) ten (10) eggs (espohagus) at (aorta) twelve (12)"

Front 66

During quiet breathing, what muscle is used for inspiration?

Back 66

The diaphragm

Front 67

During quiet breathing, what muscle is used for expiration?

Back 67

No muscles are used; the expiration of quiet breathing is passive

Front 68

During exercise, what three muscle groups are used for inspiration?

Back 68

The external intercostals, the scalene muscles, and the sternomastoids

Front 69

During exercise, what four abdominal wall muscle groups are for expiration?

Back 69

The rectus abdominus, the internal obliques, the external obliques, and the transversus abdominus

Front 70

During exercise, what chest wall muscles are used for expiration?

Back 70

The internal intercostals

Front 71

While expiration during quiet breathing is _____ (active/passive), expiration during exercise is _____ (active/passive).

Back 71

Passive; active

Front 72

What lung product is produced by type II pneumocytes?

Back 72

Surfactant

Front 73

True or False: Surfactant functions to decrease alveolar surface tension.

Back 73

true

Front 74

True or False: Surfactant functions to decrease compliance.

Back 74

False; surfactant increases compliance

Front 75

True or False: Surfactant has no effect on the work of inspiration.

Back 75

False; it decreases the work of inspiration

Front 76

What lung product inactivates bradykinin?

Back 76

Angiotensin-converting enzyme

Front 77

What lung product activates bradykinin?

Back 77

Kallikrein

Front 78

In addition to inactivating bradykinin, what other reaction does angiotensin-converting enzyme catalyze?

Back 78

The conversion of angiotensin I to angiotensin II

Front 79

What effect do angiotensin-converting enzyme inhibitors have on serum levels of bradykinin?

Back 79

ACE inhibitors increase bradykinin levels-- leading to cough and angioedema

Front 80

Angiotensin-converting enzyme inhibitors increase bradykinin, which leads to which two common adverse effects?

Back 80

Cough and angioedema

Front 81

In addition to surfactant, angiotensin-converting enzyme, and kallikrein, what are two other important lung products?

Back 81

Prostaglandins and histamine

Front 82

What are two other names for surfactant?

Back 82

Dipalmitoyl phosphatidylcholine and lecithin

Front 83

A deficiency of surfactant leads to what neonatal condition?

Back 83

Respiratory distress syndrome

Front 84

Give the equation for calculating collapsing pressure.

Back 84

Collapsing pressure = 2 × tension / radius

Front 85

What is the effect of histamine on the airways in the lung?

Back 85

Increases bronchoconstriction

Front 86

In the lung, _____ (angiotensin-converting enzyme/kallikrein) inactivates bradykinin, _____ (angiotensin-converting enzyme/kallikrein) activates bradykinin.

Back 86

Angiotensin-converting enzyme; kallikrein

Front 87

There is a tendency for the alveoli to collapse on _____ (expiration/inspiration) as the radius _____ (decreases/increases).

Back 87

expiration; decreases

Front 88

What is the term for the volume of air in the lungs after maximal expiration?

Back 88

Residual volume

Front 89

What is the term for the volume of air that can still be breathed out after normal expiration?

Back 89

Expiratory reserve volume

Front 90

What is the term for the volume of air that moves into the lungs with each quiet inspiration?

Back 90

Tidal volume

Front 91

How much is the typical tidal volume?

Back 91

500 mL

Front 92

What is the term for the volume of air in excess of tidal volume that moves into the lung on maximum inspiration?

Back 92

Inspiratory reserve volume

Front 93

What is the term for the difference between the total lung capacity and residual volume called?

Back 93

Vital capacity

Front 94

Vital capacity equals the sum of what three lung volumes?

Back 94

Tidal volume, inspiratory reserve volume, and expiratory reserve volume

Front 95

The residual volume plus the expiratory reserve volume equals what?

Back 95

The functional reserve capacity

Front 96

Describe the functional reserve capacity.

Back 96

The volume left in the lungs after normal expiration

Front 97

The inspiratory reserve volume plus the tidal volume equals what?

Back 97

Inspiratory capacity

Front 98

The inspiratory reserve volume plus the tidal volume plus the expiratory reserve volume plus the residual volume equals what?

Back 98

Total lung capacity

Front 99

In reference to lung volume, what is the sum of two or more volumes called?

Back 99

Capacity

Front 100

What is the term for the lung volume that includes all capacity except the residual volume?

Back 100

Vital capacity

Front 101

Which lung volume cannot be measured on spirometry: inspiratory reserve volume, tidal volume, expiratory reserve volume, or residual volume?

Back 101

Residual volume

Front 102

Give the formula for calculating dead space volume.

Back 102

Dead space volume = tidal volume × [(partial arterial pressure of carbon dioxide - partial expiratory pressure of carbon dioxide) / partial arterial pressure of carbon dioxide]

Front 103

Physiological dead space includes the anatomical dead space of the _____ (conducting/respiratory) airways plus the functional dead space in _____ (alveoli/bronchioles).

Back 103

Conducting; alveoli

Front 104

True or False: Physiologic dead space refers to inspired air that takes part in gas exchange.

Back 104

False; physiologic dead space refers to inspired air that does not take part in gas exchange

Front 105

Which section of the healthy lung contributes more to functional dead space: the apex or the base?

Back 105

The apex

Front 106

There is a tendency for lungs to collapse _____ (inward/outward) and the chest wall to spring _____ (inward/outward).

Back 106

Inward; outward

Front 107

At the point of functional residual capacity (i.e., at the end of a normal expiration), what is the value of the pressure within the lungs?

Back 107

At FRC, the pressure within the lungs is equal to atmospheric pressure

Front 108

What balances the inward pull of the lung at the point of functional residual capacity (i.e. at the end of a normal expiration)?

Back 108

The outward pull of the chest wall

Front 109

How many polypeptide subunits make up hemoglobin?

Back 109

four

Front 110

Adult hemoglobin is formed from two _____ subunits and two _____ subunits.

Back 110

alpha, beta

Front 111

What are the two conformation forms of hemoglobin?

Back 111

Relaxed and taut

Front 112

Which form of hemoglobin has a low affinity for oxygen, relaxed or taut?

Back 112

Taut

Front 113

What shape is the hemoglobin-oxygen dissociation curve?

Back 113

It is sigmoid shaped

Front 114

Which form of hemoglobin has a high affinity for oxygen, relaxed or taut?

Back 114

relaxed

Front 115

True or False: Both hemoglobin and myoglobin share the same sigmoid-shaped oxygen binding curve.

Back 115

False; only hemoglobin has a sigmoid-shaped binding curve

Front 116

Does hemoglobin have positive or negative cooperativity?

Back 116

Positive; the more oxygen molecules bind, the more affinity hemoglobin has for additional oxygen molecules

Front 117

Does a right shift of the hemoglobin-oxygen dissociation curve lead to increased or decreased oxygen unloading?

Back 117

Increased

Front 118

To increase oxygen unloading, should the hemoglobin-oxygen dissociation curve be shifted to the left or the right?

Back 118

The right

Front 119

Fetal hemoglobin is composed of two ____ subunits and two ____ subunits.

Back 119

α (alpha); γ (gamma-- babies go gaga)

Front 120

Does fetal hemoglobin have a higher or lower affinity for oxygen as compared with adult hemoglobin?

Back 120

higher

Front 121

Does fetal hemoglobin have a higher or lower affinity for 2,3-biphosphoglycerate as compared with adult hemoglobin?

Back 121

lower

Front 122

An increase in which 5 factors will favor the taut form of hemoglobin over the relaxed form?

Back 122

Cl-, H+, CO2, 2,3-BPG, and temperature

Front 123

Favoring the taut form of hemoglobin over the relaxed form will cause the dissociation curve to shift in which direction?

Back 123

Right

Front 124

An _____ (increase/decrease) in Cl-, H+, CO2, 2,3-BPG, and temperature will cause the oxygen dissociation curve to shift to the left.

Back 124

decrease

Front 125

Which form of hemoglobin will lead to decreased oxygen unloading?

Back 125

relaxed-- increased affinity for o2

Front 126

Does carbon dioxide bind to the globin or heme portion of the hemoglobin molecule?

Back 126

Globin

Front 127

Does carbon dioxide binding to hemoglobin promote the stability of the taut or relaxed form?

Back 127

taut- to increase unloading of O2 at sites with high CO2 production/metabolic demand

Front 128

True or False: Carbon dioxide binds to the N terminus of the globin molecule.

Back 128

true

Front 129

Does carbon dioxide binding to hemoglobin promote or inhibit the unloading of oxygen?

Back 129

It promotes the unloading of oxygen, via negative allosteric regulation

Front 130

What is the direction of the net transport of carbon dioxide between the lungs and the peripheral tissues?

Back 130

From the tissues to the lungs; the opposite of net oxygen movement

Front 131

What is the primary form of carbon dioxide as it is transported in the blood from the peripheral tissues to the lungs?

Back 131

Bicarbonate

Front 132

Does hemoglobin contain iron in the oxidized state or in the reduced state?

Back 132

The reduced state
(Fe2+)

Front 133

Does hemoglobin contain Fe2+ or Fe3+?

Back 133

Fe2+

Front 134

Does hemoglobin contain ferric iron or ferrous iron?

Back 134

Ferrous iron (Fe2+)

Front 135

Does methemoglobin contain iron in the oxidized state or the reduced state?

Back 135

The oxidized state
(Fe3+)-- cannot carry oxygen as well, but carries CN- much better

Front 136

Does methemoglobin contain Fe2+ or Fe3+?

Back 136

Fe3+

Front 137

Does methemoglobin contain ferric iron or ferrous iron?

Back 137

Ferric iron
(fe3+)

Front 138

Hemoglobin contains _____ (ferric/ferrous) iron, whereas methemoglobin contains _____ (ferric/ferrous) iron.

Back 138

Ferrous; ferric

Front 139

What are the mechanisms of action of nitrites and thiosulfate in the treatment of cyanide poisoning?

Back 139

Nitrites oxidize the iron in hemoglobin to form methemoglobin; methemoglobin then binds to cyanide ions, which in turn allows cytochrome oxidase to function; after administering nitrites, thiosulfate is used to bind to the cyanide-methemoglobin complexes, to form thiocyanate, which is renally excreted

Front 140

Hemoglobin contains ____ (Fe2+/Fe3+), whereas methemoglobin contains ____ (Fe2+/Fe3+).

Back 140

Fe2+; Fe3+

Front 141

When another molecule, such as CO, binds to hemoglobin in place of oxygen, what are the systemic effects?

Back 141

This leads to tissue hypoxia from decreased oxygen saturation and decreased oxygen content in the blood

Front 142

Hemoglobin contains iron that is _____ (oxidized/reduced), whereas methemoglobin contains iron that is _____ (oxidized/reduced).

Back 142

Reduced; oxidized

Front 143

Which has a higher affinity for oxygen, hemoglobin or methemoglobin?

Back 143

Hemoglobin

Front 144

What is the treatment for toxic levels of methemoglobin?

Back 144

Methylene blue; remember the mnemonic: METHemoglobinemia can be treated with METHylene blue

Front 145

Which has a higher affinity for cyanide, hemoglobin or methemoglobin?

Back 145

Methemoglobin

Front 146

What is the name of a form of hemoglobin in which carbon monoxide is bound instead of oxygen?

Back 146

Carboxyhemoglobin

Front 147

True or False: Carbon monoxide has a greater affinity for hemoglobin than oxygen does.

Back 147

True; CO has 200x the affinity of oxygen

Front 148

Nitrates are used to treat cyanide poisoning because these drugs oxidize hemoglobin into methemoglobin. The production of methemoglobin allows which enzyme to function?

Back 148

Cytochrome oxidase

Front 149

In treating cyanide poisoning, ______ is the compound used to bind cyanide, forming _____ which is a renally excretable compound.

Back 149

Thiosulfate; thiocyanate

Front 150

What is the treatment for cyanide poisoning?

Back 150

Nitrites, and subsequently thiosulfate

Front 151

The formation of carboxyhemoglobin is associated with a _____ (left/right) shift in the oxygen-hemoglobin dissociation curve, which causes _____ (decreased/increased) oxygen-binding capacity, and thus _____ (decreased/increased) oxygen unloading in tissues.

Back 151

Left; decreased; decreased

Front 152

When the oxygen-hemoglobin dissociation curve shifts to the right, what happens to the affinity of hemoglobin for oxygen?

Back 152

A right shift decreases the affinity of hemoglobin for oxygen

Front 153

When the oxygen-hemoglobin dissociation curve shifts to the right, what happens to the P50?

Back 153

A right shift increases the P50, indicating that higher oxygen pressure is required to saturate hemoglobin

Front 154

A shift of the oxygen-hemoglobin dissociation curve to the right facilitates what process in tissue?

Back 154

The unloading of oxygen to tissue

Front 155

When the oxygen-hemoglobin dissociation curve shifts to the left, what happens to the affinity of hemoglobin for oxygen?

Back 155

A left shift increases the affinity of hemoglobin for oxygen

Front 156

When the oxygen-hemoglobin dissociation curve shifts to the left, what happens to the P50?

Back 156

A left shift decreases the P50; hemoglobin is saturated at lower pressures of oxygen

Front 157

A decrease in metabolic needs causes a _____ (left/right) shift of the oxygen-hemoglobin dissociation curve.

Back 157

Left

Front 158

A decrease in the partial pressure of carbon dioxide causes a _____ (left/right) shift in the oxygen-hemoglobin dissociation curve.

Back 158

Left

Front 159

A decrease in temperature causes a _____ (left/right) shift in the oxygen-hemoglobin dissociation curve.

Back 159

Left

Front 160

A decrease in hydrogen causes a _____ (left/right) shift in the oxygen-hemoglobin dissociation curve?

Back 160

Left

Front 161

A decrease in pH causes a _____ (left/right) shift in the oxygen-hemoglobin dissociation curve.

Back 161

Right

Front 162

A decrease in 2,3-diphosphoglycerate causes a _____ (left/right) shift in the oxygen-hemoglobin dissociation curve.

Back 162

Left

Front 163

The oxygen-hemoglobin dissociation curve for fetal hemoglobin is shifted in what direction?

Back 163

Left; fetal hemoglobin has higher affinity for oxygen than adult hemoglobin

Front 164

When the oxygen-hemoglobin dissociation curve shifts to the right, what happens to the affinity of hemoglobin for oxygen?

Back 164

A right shift decreases the affinity of hemoglobin for oxygen

Front 165

An increase in metabolic needs causes a _____ (left/right) shift in the oxygen-hemoglobin dissociation curve.

Back 165

Right

Front 166

An increase in the partial pressure of carbon dioxide causes a _____ (left/right) shift in the oxygen-hemoglobin dissociation curve.

Back 166

right

Front 167

An increase in temperature causes a _____ (left/right) shift in the oxygen-hemoglobin dissociation curve.

Back 167

right

Front 168

An increase in hydrogen causes a _____ (left/right) shift in the oxygen-hemoglobin dissociation curve.

Back 168

right

Front 169

An increase in pH causes a ______ (left/right) shift in the oxygen-hemoglobin dissociation curve.

Back 169

left

Front 170

High altitude induces what change in the oxygen-hemoglobin dissociation curve?

Back 170

right shift

Front 171

An increase in the partial pressure of carbon dioxide causes a _____ (left/right) shift in the oxygen-hemoglobin dissociation curve.

Back 171

right

Front 172

An increase in temperature causes a _____ (left/right) shift in the oxygen-hemoglobin dissociation curve.

Back 172

right

Front 173

An increase in hydrogen causes a _____ (left/right) shift in the oxygen-hemoglobin dissociation curve.

Back 173

right

Front 174

An increase in pH causes a ______ (left/right) shift in the oxygen-hemoglobin dissociation curve.

Back 174

left

Front 175

High altitude induces what change in the oxygen-hemoglobin dissociation curve?

Back 175

right shift

Front 176

An increase in 2,3-diphosphoglycerate causes a _____ (left/right) shift in the oxygen-hemoglobin dissociation curve.

Back 176

right

Front 177

In the oxygen-hemoglobin dissociation curve, what values are represented by the x and y axes?

Back 177

The partial pressure of oxygen represents the x axis, while hemoglobin saturation represents the y-axis

Front 178

Hemoglobin can bind 4 oxygen molecules and has a higher affinity for each subsequent oxygen molecule bound. What is the term for this phenomenon?

Back 178

Positive cooperativity

Front 179

An increase in the amounts of which 6 factors causes a right shift of the oxygen-hemoglobin dissociation curve?

Back 179

CO2, hydrogen ions (therefore acidity), altitude, 2,3-DPG, metabolic needs (i.e., exercise), and temperature; remember the mnemonic: CADET face right: CO2, Acid/Altitude, DPG (2,3-DPG), Exercise, Temperature

Front 180

Normally, pulmonary circulation is a _____ (high/low) resistance, _____ (high/low) compliance system.

Back 180

Low; high

Front 181

Within the lungs, a decrease in the partial pressure of oxygen in arterial blood causes what process to occur within the vasculature in the area?

Back 181

Hypoxic vasoconstriction
--- to shift blood to areas that are ventilated and thus can contribute positively to blood oxygen levels

Front 182

Within the lungs, hypoxic vasoconstriction serves what physiologic function?

Back 182

It shifts blood away from the poorly ventilated regions of the lung to the well-ventilated regions of the lung

Front 183

Under normal, healthy conditions, is oxygen a perfusion-limited gas or a diffusion-limited gas?

Back 183

Perfusion-limited gas

Front 184

Is carbon dioxide a perfusion-limited gas or a diffusion-limited gas?

Back 184

Perfusion-limited gas

Front 185

Is nitrous oxide a perfusion-limited gas or a diffusion-limited gas?

Back 185

Perfusion-limited gas

Front 186

Is carbon monoxide a perfusion-limited gas or a diffusion-limited gas?

Back 186

Diffusion-limited gas

Front 187

Under conditions of strenuous exercise, is oxygen a perfusion-limited gas or a diffusion-limited gas?

Back 187

Diffusion-limited gas

Front 188

Under what condition is oxygen a perfusion-limited gas?

Back 188

In normal health

Front 189

Under perfusion-limited conditions, where along the length of the capillary do the partial pressures of a gas equilibrate?

Back 189

early

Front 190

Under perfusion-limited conditions, how can gas exchange be increased?

Back 190

By increasing blood flow

Front 191

True or False: Under perfusion-limited conditions, the only way to increase diffusion is to increase blood flow.

Back 191

True

Front 192

List two gases that can be diffusion limited.

Back 192

Oxygen and carbon monoxide

Front 193

Under what conditions is oxygen a diffusion-limited gas?

Back 193

Exercise, emphysema, and fibrosis

Front 194

Under diffusion-limited conditions, where along the length of the capillary does the gas equilibrate?

Back 194

Nowhere; it does not equilibrate by the time the blood reaches the end

Front 195

True or False: Under diffusion-limited conditions, the gas does not equilibrate by the time the blood reaches the end of the capillary.

Back 195

true

Front 196

What are the cardiac complications of pulmonary hypertension?

Back 196

Cor pulmonale and right ventricular failure

Front 197

True or False: Pulmonary edema is a sign of right heart failure.

Back 197

False; it is a sign of left heart failure

Front 198

True or False: Jugular venous distention is a sign of left heart failure.

Back 198

True; but it can be a sign of right heart failure as well
--typically we think of it as a sign of right heart failure with blood backing up through SVC and into the jugular veins

Front 199

What are three signs of right ventricular heart failure due to cor pulmonale?

Back 199

Jugular venous distention, edema, and hepatomegaly

Front 200

What is the equation for diffusion of a gas across a membrane?

Back 200

Vgas = A/T × Dk(P1 - P2), where A = area, T = thickness, and Dk(P1 - P2) = difference in partial pressures

Front 201

In the equation for gas diffusion, which variable is affected by emphysema and how?

Back 201

Area of membranes available for gas transfer is decreased in emphysema, causing a decrease in diffusion

Front 202

In the equation for gas diffusion, which variable is affected by pulmonary fibrosis and how?

Back 202

Thickness of the membrane is increased in pulmonary fibrosis, causing a decrease in diffusion

Front 203

What is normal pulmonary arterial pressure?

Back 203

10-14 mm Hg

Front 204

What pulmonary artery pressures define pulmonary hypertension?

Back 204

25 mm Hg or greater during rest and >35 mm Hg during exercise

Front 205

Primary pulmonary hypertension is caused by what?

Back 205

An inactivating mutation in the BMPR2 gene, which normally functions to inhibit vascular smooth muscle proliferation

Front 206

Does primary pulmonary hypertension have a good or a poor prognosis?

Back 206

Very poor; the disease is progressive and fatal

Front 207

What are some of the potential causes of secondary pulmonary hypertension?

Back 207

Chronic obstructive pulmonary disease, left-to-right shunt, mitral stenosis, recurrent thromboemboli, autoimmune disease (i.e., systemic sclerosis), sleep apnea, or living at high altitudes

Front 208

What are three pathological changes in the vasculature caused by pulmonary hypertension?

Back 208

Atherosclerosis, medial hypertrophy, and intimal fibrosis of the pulmonary arteries

Front 209

How does COPD cause pulmonary hypertension?

Back 209

By the destruction of lung parenchyma and subsequent vasoconstriction due to hypoxia

Front 210

How does mitral stenosis cause pulmonary hypertension?

Back 210

By increasing resistance to blood flow in the left heart; thus causing a build-up of pressure starting in the left atrium and backing up to the pulmonary vasculature

Front 211

How do recurrent thromboemboli cause pulmonary hypertension?

Back 211

By decreasing the cross-sectional area of the pulmonary vascular bed

Front 212

How can autoimmune disease cause pulmonary hypertension?

Back 212

Processes such as systemic sclerosis lead to inflammation, then to intimal fibrosis, which in turn leads to medial hypertrophy in the pulmonary vasculature

Front 213

How does left-to-right shunt cause pulmonary hypertension?

Back 213

By causing increased shear stress (due to increased volume in the right ventricle), and thus endothelial injury

Front 214

How do sleep apnea or living at high altitudes cause pulmonary hypertension?

Back 214

Sleep apnea and living at high altitudes cause hypoxia, which in turn causes pulmonary vasoconstriction

Front 215

What are the sequelae of pulmonary hypertension if left untreated?

Back 215

Severe respiratory distress, leading to cyanosis and right ventricular hypertrophy, leading to death from decompensated cor pulmonale

Front 216

What enters RBCs to allow HCO3- (bicarbonate) to exit?

Back 216

Cl- (chloride shift) to maintain charge neutrality-- one anion leaves and another is taken in

Front 217

How is pulmonary vascular resistance calculated?

Back 217

Pulmonary vascular resistance = (pressure in the pulmonary artery minus pressure in the left atrium) divided by the cardiac output

Front 218

Pressure in the left atrium is equal to what measurement of pulmonary venous resistance?

Back 218

Wedge pressure

Front 219

Pulmonary vascular resistance is _____ (directly/inversely) related to airway length and _____ (directly/inversely) related to vessel radius.

Back 219

Directly; inversely

Front 220

Which two factors increase pulmonary vascular resistance?

Back 220

Increased viscosity of blood and increased vessel length

Front 221

What enters RBCs to allow HCO3- (bicarbonate) to exit?

Back 221

Cl- (chloride shift) to maintain charge neutrality-- one anion leaves and another is taken in

Front 222

How is pulmonary vascular resistance calculated?

Back 222

Pulmonary vascular resistance = (pressure in the pulmonary artery minus pressure in the left atrium) divided by the cardiac output

Front 223

Pressure in the left atrium is equal to what measurement of pulmonary venous resistance?

Back 223

Wedge pressure

Front 224

Pulmonary vascular resistance is _____ (directly/inversely) related to airway length and _____ (directly/inversely) related to vessel radius.

Back 224

Directly; inversely

Front 225

Which two factors increase pulmonary vascular resistance?

Back 225

Increased viscosity of blood and increased vessel length

Front 226

What is the equation for resistance, given vessel length, diameter, and blood viscosity?

Back 226

R = (8ηl) / (πr4), where η = viscosity of blood, l = vessel length, and r = vessel radius

Front 227

How is the oxygen content of the blood calculated?

Back 227

Oxygen content of the blood = (oxygen-binding capacity × percent saturation) + dissolved oxygen

Front 228

How much oxygen can 1 g of hemoglobin bind?

Back 228

1.34 mL

Front 229

What is the average amount of hemoglobin in normal blood?

Back 229

About 15 g/dL

Front 230

What is the normal oxygen-binding capacity of the blood?

Back 230

About 20.1 mL oxygen/dL of blood

Front 231

True or False: When the hemoglobin level falls, the oxygen content of the blood falls.

Back 231

True, because oxygen-binding capacity depends on the total amount of hemoglobin

Front 232

True or False: When the hemoglobin level falls, the percent oxygen saturation of the blood falls.

Back 232

False; the blood can still be 100% saturated; there will be less oxygen binding capacity and hence lower oxygen content

Front 233

A decrease in hemoglobin will have what effect on the oxygen content of arterial blood: decrease, increase, or no change?

Back 233

decrease

Front 234

A decrease in hemoblogin will have what effect on oxygen saturation: decrease, increase, or no change?

Back 234

no change

Front 235

A decrease in hemoglobin will have what effect on partial oxygen pressure: decrease, increase, or no change?

Back 235

no change

Front 236

Visible cyanosis typically results when deoxygenated hemoglobin is at what level?

Back 236

> 5 g/dL

Front 237

Why does arterial partial pressure of oxygen decrease with chronic lung disease?

Back 237

Physiologic shunt decreases the oxygen extraction ratio

Front 238

What is the formula for oxygen delivery to tissues?

Back 238

Oxygen delivery to tissues = cardiac output × oxygen content of blood

Front 239

What is the alveolar gas equation?

Back 239

Alveolar partial pressure of oxygen (in mm Hg) = the partial pressure of oxygen in inspired air minus (alveolar partial carbon dioxide pressure divided by the respiratory quotient); or, PAo2 = PIo2 - (PAco2 / R)

Front 240

How can the alveolar gas equation be simplified and approximated (assuming that the patient is on room air)?

Back 240

Alveolar partial pressure of oxygen = 150 - (arterial partial pressure of carbon dioxide / 0.8)

Front 241

What gradient is equal to the alveolar partial pressure of oxygen minus the arterial partial pressure of oxygen?

Back 241

The alveolar-arterial gradient (the A-a gradient)

Front 242

What is the normal alveolar-arterial gradient?

Back 242

10-15 mmHg

Front 243

What three pathological processes can lead to increased A-a gradient?

Back 243

Shunting, V/Q mismatch, and fibrosis of the lungs

Front 244

Name 5 processes that can lead to hypoxemia (i.e., decreased arterial oxygen).

Back 244

High altitude, hypoventilation, V/Q mismatch, diffusion limitation, and right-to-left shunt

Front 245

Name 5 processes that can lead to hypoxia (i.e. decreased oxygen delivery to tissue).

Back 245

Decreased cardiac output, hypoxemia, anemia, cyanide poisoning, and carbon monoxide poisoning

Front 246

Name 2 processes that can lead to ischemia (i.e. loss of blood flow)

Back 246

Impeded arterial flow, and reduced venous drainage

Front 247

What is the difference between hypoxemia and hypoxia?

Back 247

Hypoxemia refers to decreased arterial partial pressure of oxygen and can lead to hypoxia, which is defined as decreased oxygen delivery to tissue

Front 248

Which 2 processes lead to hypoxemia with a normal A-a gradient?

Back 248

High altitude and hypoventilation

Front 249

Which 3 processes can lead to hypoxemia with an increased A-a gradient?

Back 249

V/Q mismatch, diffusion limitation (e.g. fibrosis), and right-to-left shunt

Front 250

Ideally, adequate gas exchange requires _____ to be in equilibrium with _____.

Back 250

Ventilation; perfusion

Front 251

The equation V/Q = 1 represents what condition?

Back 251

Ventilation that is matched with perfusion

Front 252

Within what part of the lung does ventilation/perfusion equal about 3?

Back 252

The apex of the lung

Front 253

In the apex of the lung, there is wasted _____ (perfusion/ventilation).

Back 253

ventilation

Front 254

Within what part of the lung does ventilation/perfusion equal about 0.6?

Back 254

base

Front 255

In the base of the lung, there is wasted _____ (perfusion/ventilation).

Back 255

perfusion

Front 256

Is ventilation greater at the base of the lung or the apex of the lung?

Back 256

base

Front 257

Is perfusion greater at the base of the lung or the apex of the lung?

Back 257

base of the lung

Front 258

With exercise, what happens to the apical capillaries?

Back 258

They vasodilate resulting in a V/Q ratio that approaches 1

Front 259

The vasodilation of the apical capillaries that occurs with exercise results in what change to the ventilation/perfusion ratio?

Back 259

The V/Q ratio approaches 1

Front 260

Microorganisms that thrive in high-oxygen environments, such as tuberculosis, flourish in which part of the lungs?

Back 260

apex

Front 261

True or False: Tuberculosis is an example of an organism that thrives in the high-oxygen environment of the apical lungs.

Back 261

true

Front 262

A ventilation/perfusion ratio that approaches 0 for a given area of lung indicates that what is occurring in that area?

Back 262

airway obstruction-- there is no ventilation, but there is perfusion

Front 263

What is the name for the process whereby airway obstruction leads to perfusion with no ventilation within an area of the lungs?

Back 263

shunt

Front 264

A ventilation/perfusion ratio that approaches infinity for a given area of lung indicates that what is occurring in that area?

Back 264

Blood flow obstruction (i.e., pulmonary embolus)
(dead space)

Front 265

When blood flow (but not airflow) into an area of the lungs is obstructed such that the ventilation/perfusion ratio approaches infinity, the area can be considered what?

Back 265

dead space

Front 266

Which zone of the lung is associated with wasted ventilation?

Back 266

the apex/zone 1

Front 267

Which zone of the lung is associated with wasted perfusion?

Back 267

the base/ zone 3

Front 268

In hypoxia due to _____ (dead space/shunting), 100% oxygen does not improve the partial pressure of oxygen; while in hypoxia due to increased _____ (dead space/shunting), there is an improvement in the partial pressure of oxygen.

Back 268

shunting; deadspace

Front 269

In the lung apex (zone 1), arrange the following in order of increasing pressure: artery, vein, alveolus.

Back 269

Vein < artery< alveolus

Front 270

In zone 2 of the lung, arrange the following in order of increasing pressure: artery, vein , alveolus

Back 270

Vein < alveolus < artery

Front 271

In the lung base (zone 3), arrange the following in order of increasing pressure: artery, vein, alveolus.

Back 271

Alveolus < vein < artery

Front 272

What process causes the ventilation at the apex of the lungs to be considered "wasted?"

Back 272

The high alveolar pressure at the apex causes compression of the capillaries, and thus an inability to undertake gas exchange with the blood vessels

Front 273

In how many different forms is carbon dioxide transported from the tissues to the lungs?

Back 273

Three: (1) as bicarbonate, (2) bound to hemoglobin as carbaminohemoglobin, and (3) dissolved

Front 274

Ninety percent of the carbon dioxide transported from the tissues to the lungs is in what form?

Back 274

Bicarbonate

Front 275

Other than as bicarbonate, in what two other ways is carbon dioxide transported from the tissues to the lungs?

Back 275

Bound to hemoglobin as carbaminohemoglobin and dissolved as carbon dioxide

Front 276

What is carbon dioxide that is bound to hemoglobin called?

Back 276

Carbaminohemoglobin

Front 277

What percentage of carbon dioxide gets transported from the tissues to the lungs as carbaminohemoglobin?

Back 277

About 5%

Front 278

What percentage of carbon dioxide gets transported from the tissues to the lungs as dissolved carbon dioxide?

Back 278

About 5%

Front 279

After it is inside an RBC, each carbon dioxide molecule combines with a molecule of what compound?

Back 279

Water

Front 280

After it is inside an RBC, each carbon dioxide molecule combines with a water molecule to become what compound?

Back 280

Carbonic acid (H2CO3)

Front 281

What enzyme catalyzes the conversion of carbon dioxide and water into carbonic acid?

Back 281

Carbonic anhydrase

Front 282

Within an RBC, the carbonic acid formed from the combination of carbon dioxide and water dissociates into what two compounds?

Back 282

Hydrogen and bicarbonate

Front 283

What is the fate of the bicarbonate that results from the deprotonation of carbonic acid within an RBC?

Back 283

It gets exchanged out of the RBC for a chloride molecule that enters the RBC

Front 284

In the lungs, the oxygenation of hemoglobin promotes what?

Back 284

The dissociation of a proton from hemoglobin and hence a decrease in pH

Front 285

What is the name for the effect in which the oxygenation of hemoglobin within the lungs promotes the dissociation of carbon dioxide from hemoglobin?

Back 285

The Haldane effect

Front 286

In reference to carbon dioxide transport, in which direction will the lower pH of peripheral tissues (compared ot the lungs) shift the oxygen dissociation curve?

Back 286

to the right

Front 287

In peripheral tissues, the right shift of the hemoglobin dissociation curve that results from lower pH promotes what?

Back 287

unloading of Oxygen

Front 288

In peripheral tissues, the right shift of the oxygen dissociation curve that results from decreased pH causes an unloading of oxygen. What is this effect called?

Back 288

The Bohr effect

Front 289

Acutely, what happens to ventilation as a response to high altitude?

Back 289

Ventilation is increased --> respiratory alkalosis

Front 290

Chronically, what happens to ventilation as a response to high altitude?

Back 290

Ventilation is increased

Front 291

What happens to erythropoietin levels as a response to high altitude?

Back 291

increased

Front 292

What two laboratory parameters increase as a result of the increased erythropoietin levels that result from being at high altitudes?

Back 292

Hematocrit and hemoglobin

Front 293

What happens to the level of 2,3-diphosphoglycerate in response to high altitude?

Back 293

increases

Front 294

What substance binds to hemoglobin so that hemoglobin releases more oxygen?

Back 294

2,3-Diphosphoglycerate; increased concentrations shift the hemoglobin dissociation curve to the right

Front 295

What cellular changes occur in response to high altitude?

Back 295

There is an increase in mitochondria

Front 296

Increased renal excretion of what substance occurs in response to high altitude?

Back 296

Bicarbonate- to compensate for the respiratory alkalosis

Front 297

The increased renal excretion of bicarbonate that is seen in response to high altitude compensates for what?

Back 297

The respiratory alkalosis that occurs as a result of increased ventilation

Front 298

The increased renal excretion of bicarbonate that is seen in response to high altitude can be augmented using what?

Back 298

Acetazolamide; the drug is a carbonic anhydrase inhibitor that makes the urine more basic

Front 299

In response to high altitude, chronic hypoxic pulmonary vasoconstriction results in what condition?

Back 299

Right ventricular hypertrophy

Front 300

As a result of exercise, what happens to carbon dioxide production in muscles?

Back 300

increases

Front 301

In response to exercise, what happens to oxygen consumption?

Back 301

increases

Front 302

Why does ventilation rate increase during exercise?

Back 302

In order to meet increasing oxygen demand

Front 303

What happens to the V/Q ratio as a response to exercise?

Back 303

It becomes more uniform from apex to base; hence gas exchange is more efficient

Front 304

What happens to pulmonary blood flow as a response to exercise?

Back 304

It increases due to increased cardiac output

Front 305

True or False: pH rises during strenuous exercise.

Back 305

False; pH decreases during stenuous exercise due to lactic acidosis

Front 306

True or False: PaO2 and PaCO2 increase in response to exercise, while venous CO2 content decreases.

Back 306

False; PaO2 and PaCO2 do not change in response to exercise but venous CO2 content increases

Front 307

What is the hallmark pulmonary function test finding in patients with obstructive lung disease?

Back 307

Decreased FEV1:FVC ratio

Front 308

Is chronic bronchitis considered an obstructive lung disease or a restrictive lung disease?

Back 308

Obstructive

Front 309

Is emphysema considered an obstructive lung disease or a restrictive lung disease?

Back 309

Obstructive

Front 310

Is asthma considered an obstructive lung disease or a restrictive lung disease?

Back 310

Obstructive

Front 311

Is bronchiectasis considered an obstructive lung disease or a restrictive lung disease?

Back 311

Obstructive

Front 312

In obstructive lung disease, there is a(n) _____ (decrease/increase) in residual volume and a(n) ____ (decrease/increase) in functional vital capacity.

Back 312

Increase; decrease

Front 313

A patient with chronic bronchitis is sometimes referred to as a "_____ _____," whereas a patient with emphysema is sometimes referred to as a "_____ _____."

Back 313

Blue bloater; pink puffer

Front 314

What type of cough do patients with chronic bronchitis tend to have?

Back 314

A chronic productive cough

Front 315

To be diagnosed with chronic bronchitis, a patient must have had a productive cough for how long?

Back 315

At least 3 consecutive months in at least 2 years

Front 316

Patients with chronic bronchitis have hypertrophy of what glands in what segments of the lungs?

Back 316

The mucus-secreting glands in the bronchioles

Front 317

The gland hypertrophy seen in chronic bronchitis can be quantified using the _____ _____, which tends to be greater than what value in symptomatic patients?

Back 317

Reid index; 50%

Front 318

What is the leading cause of chronic bronchitis?

Back 318

Smoking

Front 319

True or False: Stridor is often auscultated in the lungs of patients with chronic bronchitis.

Back 319

False; the exam findings are usually wheezing and crackles
(stridor is an inspiratory breath sound hear with epiglotitis)

Front 320

True or False: Wheezing is often auscultated in the lungs of patients with chronic bronchitis.

Back 320

true

Front 321

True or False: Crackles are often auscultated in the lungs of patients with chronic bronchitis.

Back 321

true

Front 322

What visible skin finding may be noted in patients with chronic bronchitis?

Back 322

cyanosis

Front 323

Emphysema involves an enlargement of the air spaces and a decrease in recoil that results from the destruction of the _____ _____.

Back 323

Alveolar walls

Front 324

Emphysema can be caused by what lifestyle choice and in what genetic disease?

Back 324

Smoking and α1-antitrypsin deficiency

Front 325

Smoking is associated with _____ (centriacinar/panacinar) -type emphysema, whereas α1-antitrypsin deficiency is associated with _____ (centriacinar/panacinar) -type emphysema.

Back 325

Centriacinar; panacinar

Front 326

In addition to panacinar emphysema, α1-antitrypsin deficiency also causes what condition?

Back 326

Liver cirrhosis

Front 327

A deficiency of α1-antitrypsin results in the increased activity of what enzyme?

Back 327

Elastase; the enzyme degrades elastic fibers in the lungs-- produced and released by neutrophils

Front 328

True or False: Stridor is often auscultated in the lungs of patients with emphysema.

Back 328

False; breath sounds are usually diminished with a decreased inspiratory-to-expiratory ratio

Front 329

True or False: Decreased breath sounds are often auscultated in the lungs of patients with emphysema.

Back 329

true

Front 330

True or False: A decreased inspiratory-to-expiratory ratio is often noted in the lungs of patients with emphysema.

Back 330

true

Front 331

True or False: Wheezing is often auscultated in the lungs of patients with emphysema.

Back 331

False; wheezing is associated with chronic bronchitis and asthma

Front 332

True or False: Crackles are often auscultated in the lungs of patients with emphysema.

Back 332

False; crackles are associated with chronic bronchitis

Front 333

In emphysemic lungs, there is a(n) (decrease/increase) _____ in recoil and, subsequently, a(n) _____ (decrease/increase) in compliance.

Back 333

Decrease; increase

Front 334

In emphysema, the decrease in lung recoil is a result of destruction of alveolar walls by increased activity of which enzyme?

Back 334

Elastase

Front 335

Paraseptal emphysema is associated with bullae that can rupture and lead to _____ _____ in otherwise young healthy males.

Back 335

Spontaneous pneumothorax

Front 336

Individuals with emphysema tend to exhale through pursed lips to increase _____ _____ and prevent _____ _____ during expiration.

Back 336

Airway pressure; airway collapse

Front 337

In patients with asthma, bronchial hyperresponsiveness causes reversible _____ (constriction/dilation) of the bronchioles.

Back 337

Constriction

Front 338

The definitive feature of the bronchoconstriction of asthma is that it is fully _____.

Back 338

Reversible

Front 339

In patients with asthma, there is hyperresponsiveness of what lung segment?

Back 339

The bronchi

Front 340

While chronic bronchitis is a disease of the _____ (bronchi/bronchioles), asthma is a disease of _____ (bronchi/bronchioles).

Back 340

Bronchioles; bronchi

Front 341

True or False: Kartagener's syndrome is a granulomatous condition that can cause interstitial lung disease.

Back 341

False; Kartagener's syndrome is associated with bronchiectasis and obstructive lung disease

Front 342

blocks viral penetration/uncoating(M2 protein) may buffer pH of endosome. also causes the release of dopamine from intact nerve terminals

Back 342

Amantadine

Front 343

True or False: Patients with asthma are often bradycardic.

Back 343

False; patients with asthma are often tachycardic

Front 344

What finding is commonly noted on pulmonary function testing of patients with asthma as well as those with emphysema?

Back 344

Decreased inspiratory-to-expiratory ratio

Front 345

What blood pressure/pulse finding is often observed in patients with asthma?

Back 345

Pulsus paradoxus

Front 346

What eponymous pathology finding is associated with asthma?

Back 346

Curschmann's spirals (shed epithelium from mucous plugs)

Front 347

What two pathologic findings are associated with asthma?

Back 347

Smooth muscle hypertrophy and mucous plugging

Front 348

_____ is a chronic necrotizing infection of bronchi.

Back 348

Bronchiectasis

Front 349

In bronchiectasis, chronic necrotizing infection of the bronchi leads to what?

Back 349

Permanent dilation of the airways

Front 350

Patients with bronchiectasis often have a cough productive of what?

Back 350

Blood and purulent sputum

Front 351

Which two pathologic conditions are associated with bronchiectasis?

Back 351

Cystic fibrosis and Kartagener's syndrome

Front 352

True or False: Bronchiectasis is associated with bronchial obstruction.

Back 352

true

Front 353

True or False: Bronchiectasis is associated with poor ciliary motility.

Back 353

true

Front 354

Individuals with bronchiectasis are prone to develop which fungal pulmonary infection?

Back 354

Aspergillosis

Front 355

What are three common triggers of asthma attacks?

Back 355

Viral URIs, allergens, and stress

Front 356

Chronic bronchitis is associated with _____ (early/late)-onset hypoxemia and _____ (early/late)-onset dyspnea.

Back 356

Early; late

Front 357

Emphysema is associated with ________ (early/late)-onset hypoxemia and ________ (early/late)-onset dyspnea.

Back 357

Late; early

Front 358

What causes late-onset hypoxemia in emphysema?

Back 358

The eventual loss of capillary beds, which occurs with the loss of alveolar walls

Front 359

What causes early-onset hypoxemia in chronic bronchitis?

Back 359

shunting

Front 360

Patients with _____ (emphysema/chronic bronchitis) feel dyspneic earlier in the course of the disease.

Back 360

Emphysema

Front 361

In restrictive lung disease, there is restricted lung _____ that causes decreased lung volume.

Back 361

Expansion

Front 362

What two lung volumes are typically decreased in patients with restrictive lung disease?

Back 362

Functional vital capacity and total lung capacity

Front 363

Patients with restrictive lung disease typically have an FEV1:FVC within what range?

Back 363

>80%

Front 364

What are the two general types of restrictive lung disease?

Back 364

Poor breathing mechanics (caused by musculoskeletal or connective tissue disease) and interstitial lung diseases

Front 365

Extrapulmonary causes of restrictive lung disease are generally the result of what?

Back 365

Poor breathing mechanics, usually as a result of muscular dysfunction (eg, polio) or structural difficulty (eg, scoliosis, morbid obesity)

Front 366

Pulmonary causes of restrictive lung disease are generally the result of what category of diseases?

Back 366

Interstitial lung diseases

Front 367

What infectious disease can cause poor muscular effort and thereby lead to extrapulmonary restrictive lung disease?

Back 367

Polio

Front 368

What disease of the neuromuscular junction can cause poor muscular effort and thereby lead to extrapulmonary restrictive lung disease?

Back 368

Myasthenia gravis

Front 369

True or False: Sarcoidosis can lead to poor muscular effort and thereby lead to extrapulmonary restrictive lung disease.

Back 369

False; sarcoidosis is an interstitial restrictive lung disease

Front 370

True or False: Scoliosis can cause poor structural apparatus and thereby lead to extrapulmonary restrictive lung disease.

Back 370

True

Front 371

True or False: Morbid obesity can cause poor structural apparatus and thereby lead to extrapulmonary restrictive lung disease.

Back 371

True

Front 372

True or False: Polio is an intrapulmonary process that can result in restricted lung expansion.

Back 372

False; polio is an extrapulmonary process

Front 373

True or False: Adult respiratory distress syndrome is an intrapulmonary process that can result in restricted lung expansion.

Back 373

True

Front 374

True or False: Neonatal respiratory distress syndrome is an intrapulmonary process that can result in restricted lung expansion.

Back 374

True

Front 375

What is another name for neonatal respiratory distress syndrome?

Back 375

Hyaline membrane disease

Front 376

What category of interstitial lung diseases has a clear association with an environmental exposure?

Back 376

Pneumoconioses

Front 377

used in combination with sulfonamides (TMP-SMX) causing sequential block of folate synthesis
-combo used in for what organisms?

Back 377

trimethoprim
used or UTI'S shigella, salmonella, pneumocystis carinii pneumonia

Front 378

True or False: Eosinophilic granuloma is an example of a pneumoconiosis.

Back 378

False; it is an example of interstitial lung disease

Front 379

True or False: Asbestosis is an example of a pneumoconiosis.

Back 379

true

Front 380

True or False: Sarcoidosis is a granulomatous condition that can cause interstitial lung disease.

Back 380

true- non-caseating granulomas- hilar adenopathy (more common in african american females)

Front 381

True or False: Wegener's granulomatosis is a granulomatous condition that can cause interstitial lung disease.

Back 381

true

Front 382

used against TB
delays reasistance to dapsone when used for leprosy
used for meningococcal prophylaxis in contacts of childeren with H. influenza type B

Back 382

Rifampin

Front 383

True or False: Goodpasture's syndrome is a granulomatous condition that can cause interstitial lung disease.

Back 383

False; Goodpasture's is not a granulomatous disease

Front 384

What nongranulomatous disease that commonly affects the renal and pulmonary systems can cause interstitial lung disease?

Back 384

Goodpasture's syndrome

Front 385

Idiopathic _____ _____ can cause interstitial lung disease.

Back 385

Pulmonary fibrosis

Front 386

What is another name for eosinophilic granuloma?

Back 386

Histiocytosis X = Langerhan's cell histiocytosis= Hans-Schuller Christian disease= Letterer-Siwe disease

Front 387

Name three drugs that can cause interstitial lung disease.

Back 387

Bleomycin, busulfan, and amiodarone

Front 388

What processes cause restrictive lung disease due to poor muscular effort?

Back 388

Polio and mysathenia gravis

Front 389

What processes cause restrictive lung disease due to poor structural apparatus?

Back 389

Scoliosis and morbid obesity

Front 390

What processes cause restrictive lung disease due to interstitial lung pathology?

Back 390

Acute respiratory distress syndrome, neonatal respiratory distress syndrome, pneumoconioses, sarcoidosis, idiopathic pulmonary fibrosis, Goodpasture's syndrome, Wegener's granulomatosis, eosinophil granuloma, and certain drug toxicities

Front 391

In neonatal respiratory distress syndrome, there is a deficiency of what chemical?

Back 391

Surfactant

Front 392

In neonatal respiratory distress syndrome, a surfactant deficiency leads to an increase in what?

Back 392

Surface tension

Front 393

The increased surface tension of neonatal respiratory distress syndrome results in _____ (alveolar/bronchial) ______ (collapse/hyperinflation).

Back 393

Alveolar collapse

Front 394

What cells make surfactant?

Back 394

Type II pneumocytes

Front 395

Surfactant is made most abundantly during which period of neonatal gestation?

Back 395

After the 35th week

Front 396

What ratio is used as a measure of lung maturity in neonates?

Back 396

The lecithin-to-sphingomyelin ratio

Front 397

The lecithin-to-sphingomyelin ratio within what to assess lung maturity?

Back 397

amniotic fluid

Front 398

In neonatal respiratory distress syndrome, the lecithin-to-sphingomyelin ratio is usually within what range?

Back 398

<1.5

Front 399

What is the full chemical name for surfactant?

Back 399

Dipalmitoyl phosphatidylcholine

Front 400

Medical treatment for neonatal respiratory distress syndrome includes what treatment for the mother before birth?

Back 400

Maternal steroids

Front 401

What vascular pathology is associated with persistently low oxygen tension due to neonatal respiratory distress syndrome?

Back 401

Patent ductus arteriosus

Front 402

What are three risk factors for neonatal respiratory distress syndrome?

Back 402

Prematurity, maternal diabetes (due to elevated insulin), and cesarean delivery (due to decreased release of fetal glucocorticoids)

Front 403

How can neonates be treated for RDS after birth?

Back 403

With artificial surfactant

Front 404

In acute respiratory distress syndrome, acute alveolar damage leads to a(n) _____ (decrease/increase) in alveolar capillary permeability.

Back 404

Increase

Front 405

In acute respiratory distress syndrome, an increase in alveolar capillary permeability leads to what?

Back 405

Fluid leakage into alveoli

Front 406

In acute respiratory distress syndrome, capillary leakage causes a protein-rich fluid to leak into the alveolus. What does this form?

Back 406

A hyaline membrane on the inside of the alveolus that impedes gas exchange

Front 407

In acute respiratory distress syndrome, what initial damage leads to increased capillary permeability?

Back 407

Damage to alveolar walls by substances secreted from neutrophils

Front 408

Name seven possible causes of acute respiratory distress syndrome.

Back 408

Trauma, sepsis, shock, gastric aspiration, acute pancreatitis, amniotic fluid embolism, uremia

Front 409

What obstetric complication can result in adult respiratory distress syndrome?

Back 409

Amniotic fluid embolism

Front 410

True or False: Renal failure can result in adult respiratory distress syndrome.

Back 410

True-- uremia is one of the causes of ARDS

Front 411

True or False: Unless aspiration of gastric contents occurs in an unconscious individual, trauma does not lead to adult respiratory distress syndrome.

Back 411

False; trauma may be an independent factor leading to ARDS

Front 412

True or False: Aspiration of gastric contents may lead to pneumonia, but is not a cause of adult respiratory distress syndrome.

Back 412

False; aspiration may lead to pneumonia, as well as ARDS

Front 413

A chronic alcoholic suffering from acute pancreatitis is experiencing difficulty breathing and oxygen desaturation. From what pulmonary complication of acute pancreatitis may she be suffering?

Back 413

Acute respiratory distress syndrome

Front 414

Name three molecular mechanisms that contribute to the initial damage to the alveoli in acute respiratory distress syndrome.

Back 414

Neutrophilic toxins, activation of the coagulation cascade, and oxygen-derived free radicals