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Block 3: Cardio, Renal, Pulm > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

lamberts canals

A

terminal and respiratory airways to alveoli

allows 1 alveolus to help open another

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2
Q

volatile vs. fixed acids

A

volatile: from CO2, can be eliminated by respiration (12,000-20,000 mEq/day)
fixed: from protein catabolism, eliminated by kidneys (50-100 mEq/day)

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3
Q

basal cells

A

adult stem cells of respiratory epithelium; at the base of epithelium above the basement membrane

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4
Q

AMP Kinase

A

activated with AMP:ATP ratio is low (ATP used up) that activates PGC-1alpha to go to nucleus for mitochondrial biogenesis and energy production

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5
Q

how is the epithelium in the larynx

A

false vocal cords: typical respiratory epithelium

true vocal cords: squamous epithelium

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6
Q

body’s 3 methods of preserving pH

A
  1. extracellular and intracellular buffering (sponge) - immediate
  2. respiratory adjustments - few seconds
  3. renal adjustments - hours to days
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7
Q

where are intrapleural pressures less negative? what are the implications of this?

A

the dependent portion of the lung

means that in the apex of the lung there is higher transpulmonary pressure/are already distended and less compliant

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8
Q

pink puffer

A

emphysema

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9
Q

pneumotaxic center

A

(pons) can inhibit inspiration

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10
Q

cromolyn sodium

A

asthma treatment

targets mast cells

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11
Q

mesothelioma

A

malignant tumor of the pleura assoc. with asbestos exposure

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12
Q

where is the central chemoreceptor located and what does it sense

A

brainstem (ventral surface of medulla), senses changes in CSF pH when CO2 diffuses out of cerebral capillaries

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13
Q

what is wedge a surrogate marker of?

A

left arterial pressure

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14
Q

fowler method

A

anatomic dead space

breathing in 100% O2 and wait to detect nitrogen

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15
Q

haldane effect

A

when Hb is bound to less O2 it has more affinity for CO2

H dissoc. from Hb shifts equilibrium to CO2 formation so it can leave the RBC

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16
Q

what is the A-a gradient?

A

by the time blood exits to the left heart there is a gradient between O2 in the alveolus and O2 in arterial system that creates the venous admixture (due to intrapulmonary and anatomical shunts)

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17
Q

irritant receptors

A

located between airway epithelial cells, rsponse is to constrict (from noxious gases, cigarette smoke, inhaled dust/cold air

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18
Q

J receptors

A

juxtacapillary receptors
located in alveolar walls close to capillaries, activated by engorgement of pulm caps and inc. in interstitial lung volume. result in increased breathing rate

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19
Q

what is the optimal position of a swan ganz catheter

A

zone 3 because Pa>Pv>PA

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20
Q

expiratory time constant

A

describes lung emptying

Exp TC = C x R

(in emphysema higher because higher compliance and increased resistance)

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21
Q

glutaminase

A

stimulated by low pH to make glutamate –> alpha KG –> bicarb (reabsorbed) and also make NH4 which becomes NH3 (diffuses out) and H pumped out to excrete NH4

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22
Q

cortex controls

A

voluntary ventilation (hyper/hypoventilation)

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23
Q

what happens to fixed acid?

A

100% gets excreted!
40% excreted as titratable acid and is excreted with urinary buffers
60% excreted as NH4+

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24
Q

pleurisy

A

inflammation of the pleura, secondary infection and exudate cause restriction of lung movement

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25
Dalton's law
Px=(PB-PH2O) x F
26
ventral respiratory group
(medulla) assoc with expiration
27
seromucous glands found in
extrapulmonary bronchi
28
main immune cells activated in asthma
eosinophils and mast cells mast cells = bronchoconstriction dendritic cells = release TH2 which causes B cell and Ab production which makes more mast cells and eosinophils that lead to inflammation
29
chloride shift
trade bicarb for chloride in RBC to continue driving reaction forward
30
why is nitrogen washout used?
to assess anatomic dead space - underestimate lung volumes in COPD, use C1V1=C2V2
31
where are peripheral chemoreceptors? what do they repsond to?
carotid and aortic bodies | respond to dec. PO2, inc. PCO2, dec. pH
32
inflammatory cell population differences between COPD and bronchial asthma
COPD: neutrophila, macrophages, CD8 T lymphocytes, eosinophils (exacerbations) Asthma: eosinophils, mast cells, CD4 T lymphocytes, macrophages and neutrophils
33
alpha 1 antitrypsin deficiency
increases neutrophil elastase with no antiprotease activtity
34
impaction occurs in the
nasopharynx (largest particles)
35
what does macrophage recruitment in COPD do?
Th1 and Tc1 cells --> alveolar wall destruction neutrophils (proteases like n elastase and MMP9) --> destruction and mucous hypersecretion monocytes
36
normal arterial plasma H
40 nM (means pH = 7.4)
37
sedimentation occurs in the
smaller airways (medium particles; mucocilliary transport)
38
normal values for K
3.5-5.5 mEq/L
39
hysteresis
PV curves are different for inspiration and expiration - we measure compliance on expiratory limb
40
VILI
ventilator induced lung injury (in ARDS) barotrauma, volutrauma, atalectrauma (low lung vol), biotrauma (inflammation from mediators recruited by mechanotransduction)
41
normal intrapulmonary shunt
V/Q mismatch
42
dorsal respiratory group
(medulla) assoc with inspiration
43
what is the only way to decrease mortality in ARDS
lung protective ventilation (with lower tidal volumes and airway pressures)
44
when is arterial bicarb considered saturated?
if it is over 40 mEq/L, excess gets excreted
45
triacylglycerol lipase
activated by PKA, cuts FA so they are released to make ATP
46
bowmans glands
``` secrete serous (watery/proteins) not mucous to wash away ligands/no odor fatigue in nasopharynx ```
47
DLCO
used to see lung's ability to absorb O2 - CO mean cap pressure is zero and doesn't reach equilibrium --> depends on characteristic of membrane, bf and Hb
48
hering breuer reflex
due to pulmonary stretch receptors in the lung - mechanoreceptors in SM of airways sense stretch to see if tidal volume goes higher than it should
49
where do club cells appeal
bronchioles
50
low K means...
NH3 synthesis/H excretion (low K = low H = high pH)
51
pre-botzinger complex
(medulla) pattern generator, also ventral
52
what do PAMPs and DAMPs do?
activate innate immune response which causes SIRS (systemic inflammation response syndrome) in ARDS
53
PaCo2 < expected
respiratory alkalosis
54
if a structure is above its stressed volume it wants to:
collapse/shrink | think of lungs by themselves at their unstressed volume of 150 mL
55
is deoxyHb or oxyHb a better intracellular buffer?
deoxyHb (pK is 7.9 versus oxyHb Pk is 6.7)
56
diffusion occurs in the
alveoli (smallest particles; alveolar macrophages engulf particles)
57
pores of kohn
between alveoli/cell traffiking
58
heliox is useful because
changes turbulent flow to laminar flow, result is decreased work of breathing (in asthma, COPD, tracheal mass)
59
normal albumin levels in plasma
3.5-5.5 g/dL
60
abnormal anatomical shunts
patent ductus arteriosus, VSD, pulmonary A-V anastamosis
61
PaCo2 > expected
respiratory acidosis
62
abnormal intrapulmonary shunt
decreases ventilation due to atalectesis/low compliance/high resistance/inactivated surfactant
63
albumin and alkalemia
in alkalemia, less H is bound to albumin so more Ca is bound (=less free in blood --> hypocalcemia) symptoms of hypocalcemia are respiratory alkalosis, tingling, numbness and tetany
64
Henry's law
Cx = Px x solubility
65
what do epithelial cells do in COPD?
secrete TGF beta for fibroblast proliferation/fibrosis of small airways
66
O2 content equation
O2 content = (1.32 x Hb x SaO2) + (0.0031 x PaO2)
67
delta AG < delta bicarb
non gap metabolic acidosis
68
how does epitheiulm change in the bronchioles
low pseudostratified --> ciliated columnar --> simple cuboidal
69
alveolar gas equation
PACO2 = (PIO2 - PACO2) / R
70
bronchial C fibers
response to stimulation are shallow breathing, bronchoconstriction, mucous secretion
71
total resistance of an airway is determined by:
radius of airway, length of airway, viscosity of gas
72
kartageners syndrome
immotile cilia - microtubules lack dyenin arms of ciliary anexomes
73
anti leukotrienes
asthma treatment | targets histamine, PGD2 (lead to bronchoconstriction)
74
blue bloater
chronic bronchitis
75
alveolar ventilation equation
VA=(VCO2 x K) / PACO2
76
normal anatomical shunts
thebesian veins (drains LV), bronchial veins (drain lungs right into pulmonary vein)
77
mean end pulmonary capillary gas content equation
the contribution of each area is weighted based on the amount of blood flow leaving each area, not the average of contents from all areas Ccgas = sum (%QT) (CcGas)
78
2 main extracellular buffers
CO2/HCO3 (pk=6.1) and H2PO4/HPO42- (pk=6.8)
79
at what pH does urinary H secretion stop
under 4.4 urinary pH
80
apneustic center
(pons) excitatory funciton
81
delta AG = delta bicarb
inc gap metbaolic acidosis
82
squamous metaplasia
epithelium changes from pseudostratified ciliated columnar epithelium to squamous epithelium excessive drying of the mucosa leading to change in epithelium --> severe infections
83
is the response faster in central or peripheral chemoreceptors?
peripheral! but most of the stimulus comes from central
84
limbic system and hypothalamus control
alternations in breathing patterns from emotional states
85
autophagy
process of getting rid of damaged mitochondria. phagophore engulfs mito and fuses with lysosme
86
normal values for Na
135-145 mEq/L
87
delta AG > delta bicarb
metabolic alkalosis
88
refractory hypoxemia
unresponsive to giving O2 | seen in ARDS
89
high K means...
inhibits NH3 synthesis/H excretion (high K = high H = low pH)
90
what happens to K when H concentration inside the cell increases
K decreases to try to maintain H concentration

Block 3: Cardio, Renal, Pulm (5 decks)

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