Z Boards First Aid Respiratory A&p

Front 1

airways --

cartilage is present only in the _

Back 1

trachea

bronchi

Front 2

respiratory zone includes what components _

and participates in gas exchange

Back 2

respiratory bronchioles
alveolar ducts
alveoli

Front 3

goblet cells extend only to the _

Back 3

bronchi

Front 4

pseudostratified ciliated columnar cells extend to _

Back 4

respiratory bronchioles

Front 5

type _ cells secrete pulmonary surfactant

Back 5

II

Front 6

pulmonary surfactant is named

Back 6

dipalmitoyl phosphatidylcholine

Front 7

histological classification, cell types:

type I cells are _

type II cells are _

Back 7

squamous

cuboidal

Front 8

~ lab test

_ indicates fetal lung maturity

Back 8

lecithin-to-sphingomyelin ratio of > 2.0

in amniotic fluid

Front 9

type II cells functions

Back 9

secrete surfactant

precursors to type I and type II

proliferate during lung damage

Front 10

clara cells functions

Back 10

secrete component of surfactant

degrade toxins

act as reserve cells

Front 11

clara cells description

Back 11

nonciliated

columnar with secretory granules

Front 12

clara cells functions

Back 12

secrete component of surfactant

degrade toxins

act as reserve cells

Front 13

lung endothelium is of what type?

Back 13

"continuous endothelium" with tight junctions

Front 14

anatomical / physical description of a bronchopulmonary segment

Back 14

in the center:

3^ segmental bronchus

2 arteries (bronchial and pulmonary)


along the borders:

veins and lymphatics

Front 15

if you aspirate a peanut--where will it go?

Back 15

if you're upright:

--> lower portion of right inferior lobe


if you're supine:

--> superior portion of right inferior lobe

Front 16

relationship of

pulmonary artery to the

bronchus

at each lung hilus

Back 16

RALS

right anterior

left superior

Front 17

the horizontal fissure of the right lung is at the level of

Back 17

4th rib

Front 18

big structures that perforate the diaphragm are where?

Back 18

I ate
ten eggs
at twelve

IVC -- T8
esophagus -- T10
aorta -- T12

Front 19

_ runs with the esophagus through the diaphragm

Back 19

2 trunks of vagus

Front 20

_ runs with the aorta through the diaphragm

Back 20

thoracic duct
azygous vein

Front 21

muscles of inspiration during exercise

Back 21

external intercostals

scalene muscles
sternomastoids

Front 22

muscles of expiration during exercise

Back 22

rectus abdominis
obliques
transversus abdominis

internal intercostals

Front 23

re: breathing during exercise

internal intercostals -->

external intercostals -->

Back 23

expiration

inspiration

Front 24

_ surfactant is deficient in neonatal respiratory distress syndrome

Back 24

dipalmitoyl phosphatidylcholine (lecithin)

Front 25

collapsing pressure equation

Back 25

P = 2 (surface tension) / radius

Front 26

important lung products (5)

Back 26

surfactant
prostaglandins
histamine
ACE
kallikrein

Front 27

histamine effect on the lung

Back 27

bronchoconstriction

Front 28

(2) in the lung affect bradykinin

Back 28

ACE inactivattes bradykinin

(ACE inhibitors ^ bradykinin)

kallikrein activates bradykinin

Front 29

ACE inhibitors --> re: bradykinin

Back 29

^ bradykinin

Front 30

kallikrein in the lung -->

Back 30

activates bradykinin

Front 31

lung volumes

4 ways to add up to the full lung

Back 31

TLC =

VC + RV =

IRV + TV + ERV + RV =

IC + FRC =

Front 32

bohr equation to determine physiologic dead space

Vd =

Back 32

Vt x (PaCO2 - PeCO2)/PaCO2

Vd = physiologic dead space
Vt = tidal volume

PaCO2 = arterial PCO2 (i.e. all the CO2 that's produced)

PeCO2 = expired air PCO2 i.e. all the CO2 that we're rid of

Front 33

_ is the largest contributor of functional dead space

Back 33

alveoli in apex of healthy lung

Front 34

_ pressure is 0 at what lung volume?

Back 34

airway and alveolar

functional residual capacity

Front 35

what are (3) lung pressures

at FRC?

Back 35

airway and alveolar pressures are 0

intrapleural pressure is negative

Front 36

compliance is decreased in (3)

Back 36

pulmonary fibrosis
insufficient surfactant
pulmonary edema

Front 37

how does pulmonary edema affect compliance

Back 37

decreases it

Front 38

_ form of hemoglobin has _ times as much afffinity for O2 than the _ form of hemoglobin does

Back 38

R (relaxed)

300x

T (taut)

Front 39

_ chemical changes favor _ form of hemoglobin

to increase oxygen unloading in the tissues

Back 39

^ Cl-

H+
CO2

2,3-BPG
temperature

favor the T (taut) form

Front 40

why does fetal hemoglobin have higher affinity for O2?

Back 40

fetal Hb has lower affinity for 2,3-BPG

(2,3-BPG causes oxygen unloading)

Front 41

hemoglobin modifications include (2)

Back 41

methemoglobin

carboxyhemoglobin

Front 42

methemoglobin is (2)

Back 42

oxidized form of Hb (Fe +++)

has ^ affinity for CN-

Front 43

to treat cyanide poisoning

Back 43

use nitrates to oxidize hemoglobin to methemoglobin

which binds cyanide

allowing cytochrome oxidase to function

-----------------------
use thiosulfate to bind this cyanide

forming thiocyanate, which is renally excreted

Front 44

methemoglobinemia can be treated with

Back 44

methylene blue

Front 45

carboxyhemoglobin is

Back 45

hemoglobin bound to CO in place of O2

Front 46

carboxyhemoglobin

how does it behave differently? (2)

Back 46

left shift --

v oxygen unloading in tisssues

Front 47

Hb curve diagram:

things that make it shift left

(5)

Back 47

v metabolism
v PCO2
v temperature
v H+
v 2,3-BPG

Front 48

high altitude causes _ shift in hemoglobin curve

Back 48

right shift

Front 49

what effect does BPG have on hemoglobin

Back 49

right shifts it

Front 50

what substances in the lung are perfusion-limited?

Back 50

O2 (in normal health)
CO2
N2O

Front 51

what substances in the lung are diffusion limited?

Back 51

O2 (emphasema, fibrosis)
CO

Front 52

diffusion equation for a gas in the lung. volume of gas that diffuses...

Vgas =

Back 52

A deltaP Dk / T

area
pressure difference
diffusion constant
/ thickness

Front 53

the physics reason for
v diffusion

in emphysema

Back 53

decreased area

Front 54

the physics reason for
v diffusion

in pulmonary fibrosis

Back 54

increased thickness

Front 55

normal pulmonary artery pressure

Back 55

10-14 mmHg

Front 56

pulmonary hypertension definition

Back 56

=> 25 mmHg

or > 35 mmHg during exercise

Front 57

pulmonary hypertension results in (3)

Back 57

atherosclerosis
medial hypertrophy
intimal fibrosis

Front 58

1^ pulmonary hypertension is due to _

Back 58

inactivating mutation in the
BMPR2 gene

Front 59

the BMPR2 gene

function

Back 59

inhibit vascular smooth muscle proliferation

Front 60

prognosis for 1^ pulmonary hypertension

Back 60

poor prognosis

Front 61

gene that's mutated in 1^ pulmonary htn

Back 61

BMPR2

Front 62

causes of 2^ pulmonary hypertension

Back 62

COPD
mitral stenosis
autoimmune disease
left-to-right shunt
sleep apnea
living at high altitude

Front 63

disease course of pulmonary hypertension

Back 63

severe respiratory distress-->

cyanosis and RVH-->

death from decompensated cor pulmonale

Front 64

how does COPD cause pulmonary htn?

Back 64

destruction of lung parenchyma

Front 65

how does mitral stenosis cause pulmonary htn?

Back 65

^ resistance --> ^ pressure

Front 66

how do recurrent thromboemboli cause pulmonary htn?

Back 66

v cross-sectional area of pulmonary vascular bed

Front 67

how does autoimmune disease cause pulmonary htn?

Back 67

inflammation-->
intimal fibrosis-->
medial hypertrophy

Front 68

how does L-->R shunt cause pulmonary htn?

Back 68

^ shear stress -->

endothelial injury

Front 69

how does living at high altitude cause pulmonary htn?

Back 69

hypoxic vasoconstriction

Front 70

two equations for pulmonary vascular resistance

Back 70

(Ppulm artery - P left atrium)

/ CO


R = 8 eta length / pi r^4

Front 71

O2 content of blood =

Back 71

(O2 binding capacity) x
(% saturation)

+ dissolved O2

Front 72

normally 1g Hb can bind

how much O2

Back 72

1.34 mL O2

Front 73

cyanosis results when

(Hb lab value)

Back 73

deoxygenated Hb > 5 g/dL

Front 74

O2 binding capacity =

Back 74

20.1 mL O2/dL

Front 75

blood oxygen values

_ decreases with lung disease

_ decreases as Hb falls

Back 75

arterial PO2

O2 content

Front 76

oxygen delivery to tissues =

Back 76

CO x oxygen content

Front 77

alveolar gas equation

Back 77

PA O2 =

PI O2 - (Pa CO2/R)

-----------------------
alveolar O2 =

O2 in inspired air

- arterial CO2 / R

R = CO2 produced/O2 consumed

Front 78

respiratory quotient R in the alveolar gas equation

Back 78

CO2 produced/O2 consumed

Front 79

A-a gradient is

Back 79

PA O2 - Pa O2

10-15 mmHg

Front 80

^ A-a gradient may occur in _

causes include

Back 80

hypoxemia

shunting
V/Q mismatch
fibrosis

Front 81

3 forms of oxygen deprivation

(table)

Back 81

hypoxemia: v PaO2

hypoxia: v O2 delivery to tissue

ischemia: loss of blood flow

Front 82

causes of hypoxemia

Back 82

normal A-a gradient
--high altitude
--hypoventilation

^ A-a gradient
--V/Q mismatch
--diffusion limitation
--right to left shunt

Front 83

hypoxemia means

Back 83

v PaO2

Front 84

hypoxia means

Back 84

v O2 delivery to tissue

Front 85

ischemia means

Back 85

loss of blood flow

Front 86

two hypoxemias that have a normal A-a gradient

Back 86

high altitude
hypoventilation

Front 87

3 hypoxemias that have an
^ A-a gradient

Back 87

V/Q mismatch
diffusion limitation
right-to-left shunt

Front 88

5 causes of hypoxia

Back 88

v CO
hypoxemia
anemia
cyanide poisoning
CO poisoning

Front 89

V/Q ratio at

apex

base

Back 89

3 (wasted ventilation)

0.6 (wasted perfusion)

Front 90

V/Q at the base of the lung

Back 90

V/Q = 0.6

both are greater at the base than at the apex, however

Front 91

exercise effects on V/Q ratio

Back 91

vasodilation of apical capillaries-->

V/Q ratio that approaches 1

Front 92

V/Q --> 0 means

Back 92

airway obstruction (shunt)

Front 93

in _, 100% oxygen does not improve _

Back 93

shunt

PO2

Front 94

V/Q --> infinity means

Back 94

blood flow obstruction (physiologic dead space)

Front 95

pressures in zones of the lung

1

2

3

Back 95

PA > Pa > Pv

Pa > PA > Pv

Pa > Pv > PA

Front 96

in the apex,

_ pressure is greater than another, therefore

Back 96

PA > Pa > Pv

high alveolar pressure compresses capillaries

Front 97

if carbon dioxide is bound to hemoglobin, it's called _

Back 97

carbaminohemoglobin

Front 98

Haldane effect

Back 98

in lungs, oxygenation of Hb -->

dissociation of H+ from Hb-->

shifts equilibrium toward CO2 formation-->

CO2 is released from RBC

Front 99

Bohr effect

Back 99

in peripheral tissue

^ H+ from metabolism -->

curve to shift toward right-->

unloading of O2

Front 100

which "effect" is operative in the lung, which is operative in the tissues, and what's the basic result in each?

Back 100

lungs: Haldane effect.
unloading CO2

tissue: Bohr effect
unloading O2

Front 101

respiratory system response to high altitude (7)

Back 101

acute ^ in ventilation
chronic ^ in ventilation

^erythropoetin (chronic hypoxia
^ 2,3 BPG
^ mitochondria

^ renal excretion of bicarbonate

chronic hypoxic pulmonary vasoconstriction --> RVH

Front 102

respiratory system response to exercise:

blood pressures of various molecules etc.

Back 102

no change:
--PaO2
--PaCO2

^ in venous CO2 content