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Pulmonary Review > Anatomy and Physiology > Flashcards

Anatomy and Physiology Flashcards

1
Q

What are the 10 segments of the right lung?

A

Think of the branches:

RUL:
Anterior
Posterior
Apical

RML:
Lateral
Medical

RLL:
Superior
Medialbasal
Anterior
Lateral
Posterior
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2
Q

What are the 8 segments of the left lung?

A

Think of the branches:

LUL:
Apicoposterior
Anterior

Lingula:
Superior
Inferior

LLL:
Anteromedial
Lateral
Posterior

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3
Q

This is the smallest anatomic unit that is delineated by connective tissue septa, measures 10-25mm, and has 3 components

A

Secondary lobule of Miller

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4
Q

What are contained in the 3 anatomic regions of secondary lobules:

Interlobular septa
Centrolobular
Lobular

A

Interlobular septa- pulmonary veins and lymphatics, peripheral interstitial fiber system

Centrolobular- PA and bronchiole

Lobular- lung acini

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5
Q

These respiratory cells are squamous epithelial cells, covers 90-95% of alveolar surface area, and not capable of multiplying

A

Type I pneumocytes

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6
Q

These respiratory cells are cuboidal epithelial cells, covers 3% of elveolar surface membrane, “defender of the alveolus”, make surfactant, and replicat if type I cells are damaged

A

Type II pneumocytes

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7
Q

In the alveolar-capillary unit, these have loose junctions, convert angiotensin I to II, produce adenosine and prostaglandins, inactivates bradykinin, and clears serotonin and NE

A

Capillary endothelium

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8
Q

True/False: you can also find fibroblasts, neutrophils, eosinophils, lymphocytes, plasma cells, basophils, or mast cells in the alveolar-capillary unit

A

TRUE

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9
Q

Purpose of surfactant?

A

Reuduce surface tension

Law of Lapace:
P=2T/r

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10
Q

This component of surfactant makes up 90% of surfactant, main component is DPPC, and has hydrophilic head and hydrophobic tails to reduce surface tension

A

Lipids

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11
Q

These components of the surfactant make up the remaining 10%, and consist of SP-A, SP-B, SP-C, SP-D, ABCA3, and TTF-1

A

Proteins

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12
Q

What are the function of SP-A and SP-D in surfactant?

A

Innate immunity of the lung

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13
Q

What are the function of SP-B and SP-C in surfactant?

A

Reduce surface tension

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14
Q

What are the function of ABCA3 in surfactant?

A

It’s an ATP-binding cassette family of proteins that transport surfactant

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15
Q

What are the function of TTF-1 in surfactant?

A

Surfactant regulation

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16
Q

What is the name of the zone that contains no alveoli and does not participate in gas exhange?

A

Conducting zone

Constitutes the trachea, bronchi, bronchioles, and terminal bronchioles

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17
Q

What are the two things that constitute total pulmonary resistance?

A

Airway resistance

Pulmonary tissue resistance

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18
Q

What is the law of Poiseuille that determines airway resistance?

A

P = 8ηL/πr^4

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19
Q

What’s the equation for PVR?

A

PVR= (MPAP - PCWP)/CO

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20
Q

Does the PVR increase or decrease in the following circumstance:

Increased lung volume

A

Increases by compression of alveolar vessels

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21
Q

Does the PVR increase or decrease in the following circumstance:

Gravity

A

Decrease in gravity dependent regions due to alveolar recruitment

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22
Q

Does the PVR increase or decrease in the following circumstance:

Increased pulmonary blood volume

A

Decrease due to alveolar recruitment

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23
Q

Does the PVR increase or decrease in the following circumstance:

Increased interstitial pressures

A

Increased due to compression of vessels

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24
Q

Does the PVR increase or decrease in the following circumstance:

Increased blood viscosity

A

Increased due to increased Reynolds number

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25
Q

Does the PVR increase or decrease in the following circumstance:

Positive pressure ventilation

A

Increased due to compression and derecruitment of alveolar vessels

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26
Q

Does the PVR increase or decrease in the following circumstance:

Alveolar hypoxia

A

Increased due to locally mediated hypoxic vasoconstriction

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27
Q

Does the PVR increase or decrease in the following circumstance:

Presence of angiotensin, endothelin, histamine, norepinephrine, epinephrine, a-adrenergic agonists

A

Increased

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28
Q

Does the PVR increase or decrease in the following circumstance:

Prostaglandin, prostacyclines

A

PGE1 and PGI2 - decreased

PGE2a and PGE2 - increased

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29
Q

Does the PVR increase or decrease in the following circumstance:

Bradykinin, acetylcholine, B-adrenergic agonists, NO

A

Decreased

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30
Q

Does the PVR increase or decrease in the following circumstance:

Stimulation of sympathetic innervation

A

Increased

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31
Q

Equation for PAO2 using the Dalton law of partial pressures?

A

PAO2 = FiO2(Pb - PH2O) - PaCO2/R

Pb is barometric pressure

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32
Q

What’s a normal A-a gradient?

A

5-15, but increased with age

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33
Q

Causes for increased A-a gradients?

A

Shunt-like states
VQ mismatches
Diffusion impairments

34
Q

Equation for PaCO2, describing removal of CO2based of respiratory ventilation?

A

PaCO2 = VCO2/VA x K

35
Q

Relationship of VA to minute ventilation (VE) and dead space ventilation (VD)?

A

VA = VE - VD

36
Q

Equation for the physiologic dead space of CO2 using the Bohr equation?

A

VDCO2/VT = (PaCO2 - PECO2)/PaCO2

where PECO2 is end tidal CO2

37
Q

Equation for O2 delivery to tissues (DO2)?

A

DO2 = CaO2 x CO

where CaO2 is arterial oxygen content

38
Q

Equation for CaO2?

A

CaO2 (mL/dL) = (Hgb in g/dL x 1.34 x O2sat%) + (0.003 x PaO2)

39
Q

What things can CaO2?

A

Increases in CO, Hgb, O2 saturation, or partial pressure of oxygen

40
Q

Equation for shunt fraction (Qs/Qt)?

A

Qs/Qt = (CcO2 - CaO2)/(CcO2 - CvO2)

where CcO2 is end capillary oxygen content, usually estimated from the PAO2

41
Q

A patient has a hemoglobin (Hgb) of 6, O2 saturation of 95%, PaO2 of 80, and a CO of 3 L. Would an increase in the Hgb to 8 or an increase in the PaO2 to 100 lead to a larger increase in the delivery of oxygen to the tissues?

A

Increase in the Hgb to 8 would result in a larger magnitude of increased oxygen delivery to the tissues.

CaO2 (mL/dL) = (Hgb in g/dL x 1.34 x O2sat%) + (0.003 x PaO2)

42
Q

Tell me the relationships between PA, Pa, and Pv in zone 1

A

PA > Pa > Pv

43
Q

Tell me the relationships between PA, Pa, and Pv in zone 2

A

Pa > PA > Pv

44
Q

Tell me the relationships between PA, Pa, and Pv in zone 1

A

Pa > Pv > PA

45
Q

What is the equation for the diffuse of gas through the alveolar-capillary membrane described by the Fick law of diffusion?

A

Volume of gas diffusing (mL/min) = area x diffusion coefficient x partial pressure difference across barrier/thickness of barrier

46
Q

What is perfusion-limited diffusion of gas?

A

Partial pressure of gas across the membrane has sufficient time to equilibrate as it passes through pulmonary capillaries; gas transfer is limited by perfusion, or the cardiac output (like NO)

47
Q

What is diffusion-limited diffusion of gas?

A

Partial pressure of the gas across the membrane does not equilibrate as it passes through the pulmonary capillaries and gradient is maintained; gas transfer is limited by the alveolar-capillary barrier (like carbon monoxide)

48
Q

Under normal resting conditions, how is the diffusion of oxygen and carbon dioxide?

A

Perfusion-limited

49
Q

When does the diffusion of O2 and CO2 switch to diffusion-limited?

A

Disease states (i.e. pulmonary fibrosis, high altitude)

50
Q

What can cause the following problem:

Rapid inspiratory effort shows paradoxic movement of the diaphragm

A

Unilateralized paralyzed hemidiaphragm

This is the sniff test

51
Q

What is the equation for compliance?

A

Compliance = volume/pressure

52
Q

This is the volume of gas per breath, normally ~500ml

A

Tidal volume (VT)

53
Q

This is the volume of gas left in the lungs at the end of forced expiration, normally ~1.5L

A

RV

54
Q

2 things that can affect amount of air in RV?

A

strength of muscles for expiration (neuromuscular disorders) and elastic recoil of the lungs (emphysema)

55
Q

This is the volume of gas inhaled during a forceful inspiratory effort at the end of normal inspiration

A

IRV

56
Q

Normal IRV amount?

A

~2.5L

57
Q

This is the volume of gas exhaled during a foreful expiratory breath at the end of normal expiration

A

ERV

58
Q

Normal ERV amount?

A

~1.5L

59
Q

This is the volume of gas in the lungs at the end of normal expiration, also the point where the inward elastic recoil of the ounds is opposite and equal to outward recoil of the chest

A

FRC

60
Q

Normal FRC amount?

A

3L

61
Q

This is the volume of gas inspired during maximal inspiratory effort (TV + IRV), normally 3L

A

IC

62
Q

This is the volume of gas that can be expelled after a maximal inhalation

A

VC

63
Q

This is the volume of gas in the lungs at the end of forceful inspiratory effort, normally ~6L

A

TLC

64
Q

This structure in the medullary respiration center has the following properties:

Location- Tractus solitarius
Function- Inspiratory neurons
Afferents- CN IX, X
Efferents- Contralateral spinal cord –> main input to phrenic nerves

A

DRG

65
Q

This structure in the medullary respiration center has the following properties:

Location- Nucleus ambiguus, retrofacial (Botzinger, pre-Botzinger), para-ambigualis, retro-ambigualis
Function- Inspiration and expiration neurons
Afferents- Collateral fibers from DRG
Efferents-Pharyngeal, laryngeal, intercostal muscles, Pre-Botzinger complex is the “pacemader” of the respiratory system

A

VRG

66
Q

This structure in the medullary respiration center has the following properties:

Location- lower pons
Function- terminates inspiration
Afferents- CN X
Efferents- medullary inspiration neurons

A

Apneustic center

67
Q

This structure in the medullary respiration center has the following properties:

Location- upper pons, parabrachialis medialis, Kolliker-fuse
Function- “fine tune” breathing pattern
Afferents- pulmonary inflation stretch receptor –> inhibit this group
Efferents- modulate medullary neurons

A

Pontine respiratory group (PRG)

68
Q

Where is the location of the following reflex involved in the respiratory system:

Hering-Breuer inflation reflex

A

Slowly adapting pulmonary stretch receptors in airways

69
Q

Where is the location of the following reflex involved in the respiratory system:

Hering-Breuer deflation reflex

A

Stretch, irritant, and J receptors

70
Q

Where is the location of the following reflex involved in the respiratory system:

Paradox reflex of head (sighs)

A

Stretch receptors

71
Q

Where is the location of the following reflex involved in the respiratory system:

Cough

A

Irritant receptors in upper airway

72
Q

Where is the location of the following reflex involved in the respiratory system:

Sneeze

A

Irritant receptors in nasal mucosa

73
Q

Where is the location of the following reflex involved in the respiratory system:

Chemoreceptor reflex

A

Carotid and aortic bodies

Triggered by low PaO2, High PaCO2, and low pH

74
Q

Fill in the blank:

There is a linear increase in __ when CO2 rises from 38-50mmHg

A

VA

75
Q

What things can shift the ventilator response curve (VA vs PaCO2) to the right and decrease the slope?

A

COPD
Sleep
Narcotics
Anesthesia

76
Q

What things can shift the ventilator response curve to the left?

A

Metabolic acidosis

77
Q

True or false:

Both the central and peripheal chemoreceptors respond to changes in pH, PCO2, and PO2

A

FALSE

They all respond to pH and PCO2 but only peripheral sense changes to PO2

78
Q

Delta delta gap equation?

A

ΔAG/ΔHCO3

AG-12)/(24-HCO3

79
Q

What does it mean if the delta gap is <1?

A

Larger decrease in HCO3 that we account for by the given change in AG

Indicating concomitant nongap AG metabolic acidosis is present

80
Q

What does it mean if the delta gap is 1-2?

A

Pure AG metabolic acidosis is present

81
Q

What does it mean if the delta gap is >2?

A

Smaller decrease in HCO3 that we account for by given change in AG

Indicating concomitant metabolic alkalosis

82
Q

Identify the following acid– base disorder(s):
A) pH = 7.56,
B)PCO2 =22mmHg C)PO2 =90mmHgon
35% FiO2, D) Na= 127
K= 4.0
Cl= 80 HCO3= 20 BUN= 35 Cr= 1.5 Albumin= 4.0

A

A) Triple disorder is present
B) Respiratory alkalosis C) Metabolic acidosis
(anion gap)
D) Metabolic alkalosis

Pulmonary Review (14 decks)

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