Exam 2: Blood, Respiratory, Lymph Flashcards
What is the connective tissue that is involved in transportation within the body?
Vascular connective tissues
What is the function of blood?
Transportation of O2, CO2, nutrients, wastes, hormones
Can blood thermoregulate?
Yes, as blood takes heat to the skin
Can blood regulate pH?
Yes
What enables blood to regulate fluid volume?
Its osmotic properties
How can blood “protect”?
Through its immune system (leukocytes)
Can leukocytes cause inflammation?
Yes
Can leukocytes kill microbes and cancer?
Yes
Can leukocytes make antibodies?
Yes
What are antibodies also known as?
Immunoglobulins (Ig’s) or gamma globulins
How do Ig’s and gamma globulins get rid of pathogens?
They mark pathogens for destruction by the immune system
Does blood contain clotting factors?
Yes
Does blood contain proteins that destroy pathogens?
Yes
What is the extracellular fluid component of blood before clotting?
Plasma
What is the extracellular fluid component of blood after clotting?
Serum
What are cells and platelets a part of?
The formed elements
What blood cell transports oxygen?
Erythrocytes
What blood cell is a major component of the immune system?
Leukocytes
What cell fragments initiate blood clotting?
Platelets
What is the pH of blood?
7.35-7.45
How sensitive is the body to changes in blood pH?
Very. A slight change in pH indicates a dramatic change in hydrogen ion concentration
Could a blood pH of 6.8 or 8.0 kill?
Yes, this slight variance in pH may be lethal
What percent of your body’s weight is blood?
8%
What does CO2 and H20 form?
Carbonic acid
What is the formula for carbonic acid?
H2CO3
What enzyme breaks carbonic acid into CO2 and H20?
Carbonic anhydrase
What is the formula for bicarbonate?
HCO3-
Where are HCO3- and H+ produced?
In the body’s tissues
In most situations, do you want the formula to read right to left, or left to right?
CO2 + H2O <-> H2CO3 <-> HCO3 + H+
From right to left. You want to get rid of H+ by combining it into carbonic acid, then split the carbonic acid into H20 and CO2
Where is carbonic anhydrase found?
In the erythrocytes and kidney tubules
What is the law of mass action?
If you increase a component (reactant) on one side of an equation, it forces the equation to proceed in the other direction
What takes care of CO2?
It is dumped by the lungs
What is too much CO2 called?
Hypercapnia
What is too low CO2 called?
Hypocapnia
What happens to the H+ ions when you have a respiratory/pulmonary disease such as emphysema?
There’s a high concentration of H+ ions in the blood leading to respiratory acidosis (the equation is reversed to read left to right)
What is acidosis?
Elevated H+, loss of bicarbonate
What respiratory disease usually causes respiratory acidosis?
Hypercapnia (too high CO2)
What is the most common form of acidosis?
Respiratory acidosis
What causes metabolic acidosis?
Too much H+, lactic acid, ketoacidosis, bicarbonate loss
Where is ketoacidosis seen?
In diabetes
Does kidney failure elevate or lower retained H+?
Kidney failure prevents the body from excreting H+, thus raising it in the body
What might lower bicarbonate ions in the body?
Diarrhea
Is this a symptom of acidosis?
Compensatory hyperventilation
Yes
Is this a symptom of acidosis?
CNS elevation
No. The CNS would depress with acidosis
Is this a symptom of acidosis?
pH < 7.0
Yes
Can a pH < 7.0 induce a coma?
Yes
Is this a symptom of acidosis?
Confusion, lethargy, headaches
Yes
Is this a symptom of acidosis?
Hyperactive reflexes
No. Hypoactive reflexes are a symptom
What is alkalosis?
When there is not enough H+ in the body
What can anxiety, hyperventilation, liver failure, vomiting, and hypocapnia cause?
Alkalosis
Is this symptom acidosis or alkalosis?
Over excited CNS
Alkalosis
Is this symptom acidosis or alkalosis?
Under excited CNS
Acidosis
Is this symptom acidosis or alkalosis?
Hypoventilation
Alkalosis
Is this symptom acidosis or alkalosis?
Hyperventilation
Acidosis
Is this symptom acidosis or alkalosis?
Confusion, lethargy
Acidosis
Is this symptom acidosis or alkalosis?
Irritability, agitated state, hyperactive reflexes
Alkalosis
Is this symptom acidosis or alkalosis?
Muscle contraction/tetany/twitching/convulsions
Alkalosis
Low pH means high or low acidity?
Low pH = high acidity
Low pH means lots of H+ ions or few H+ ions?
Low pH = high H+ ions
High pH means high or low acidity?
High pH = low acidity
High pH means lots of H+ ions or few H+ ions?
High pH = low H+ ions
Is trauma a leading cause of death for those aged 1-44?
Yes
What is the number 1 cause of death in the United States (according to him)
Trauma
What percentage of death by trauma is caused by hemorrhaging?
40%
What term means to “bleed out”?
Exsanguination
What are the three components of the triad of death?
Hypothermia
Acidosis
Coagulopathy
What does hypothermia mean?
Body temperature gets below 35 degrees Celsius
What is coagulopathy?
Reduced ability to form a clot
What demonstrates a potentially catastrophic disruption of homeostatic balance?
The triad of death
What is normal body temperature?
36-37 degrees Celsius
What can cause hypothermia?
Massive blood loss
How does hypothermia affect the circulatory system?
It reduces heart function and O2 delivery to tissues
How does hypothermia affect clotting?
Reduces ability to clot
What is hypothermia’s effect on infection/immunity?
Decreases immunity, increases risk of wound infection, pneumonia, and sepsis
How does acidosis affect the circulatory system?
Reduces heart function and increases risk of ventricular fibrillation
How does acidosis affect muscles?
Reduces muscle strength and increases fatigue of respiratory muscles
How does acidosis affect mental state?
Decreases mental status and incudes coma
How does acidosis affect clotting?
Reduces ability to clot
What is fibrinolysis?
Dissolving clots faster than they form (causes bleeding out)
What causes fibrinolysis?
Massive traumatic injury and blood loss
How does coagulopathy affect breathing?
Increased anaerobic respiration (without O2)
How does anerobic respiration affect the levels of lactic acid and pH?
Increases lactic acid and reduces the pH (acidosis)
How does coagulopathy affect body temperature?
Lowers body temperature
What is the fluid component of blood prior to clotting?
Plasma
What is the fluid component of blood after clotting?
Serum
Is it better to use plasma or serum for lab testing?
Serum, as there are no clotting proteins present that may interfere with tests
Where are most of the proteins in the blood made?
The liver
What proteins are the exception/not made by the liver?
Antibodies
How many proteins are made by the liver?
Over 2,000
What % of plasma proteins are albumins?
60%
What do albumins regulate?
Osmotic pressure
What percentage of plasma proteins are globulins?
36%
Which globulins transport lipids, metal ions, and fat-soluble vitamins?
Alpha and Beta globulins
What globulins are the antibodies/immunoglobulins?
Gamma globulins
What do gamma globulins do?
Mark pathogens for destruction in the immune system
What makes gamma globulins?
Leukocytes called plasma cells
What percentage of the plasma proteins are fibrinogens?
4%
What are fibrinogens important for?
Blood clotting
Are enzymes proteins in blood?
Yes
How are enzymes relevant in diagnostics?
These spill out of dead cells and are measured to diagnose disease
Where do nitrogenous wastes come from in blood?
From breakdown of proteins (DNA & RNA)
What is the MAIN nitrogenous waste?
Urea
What are other nitrogenous wastes?
Uric acid, creatinine, ammonia salts
Where do nitrogenous wastes get eliminated?
The kidneys
What are considered nutrients in the blood?
Glucose, amino acids, fatty acids, triglycerides, cholesterol, vitamins
What are examples of electrolytes in blood?
Na+, K+, Mg++, Cl-, PO4-, SO3-2, HCO3- (Bicarbonate)
Are there respiratory gasses in blood?
Yes, O2 and CO2
What hormones are in blood?
Yes, steroid hormones and protein hormones
What is osmolarity?
How much solute is dissolved
What do “hypertonic”, “hypotonic”, and “isotonic” refer to?
Osmolarity. Comparing solutions based on how much solute is in them
What can effect osmolarity?
Electrolytes, proteins, lipids, carbohydrates
What is osmolarity measured in?
mOsm (milliosmoles)
Where does water always move towards? (High or low concentration)
Water moves to the high solute (What is hypertonic)
What is the diffusion of water?
Osmosis
Osmosis moves water from…
Low solute to high solute
(High water to low water)
What is osmotic pressure?
The amount of pressure required to stop osmosis of water
What does osmotic pressure rely on?
Osmolarity
What solution has a higher solute content in comparison?
Hypertonic
What solution has a lower solute content in comparison?
Hypotonic
What is it called when solutions have equal amounts of solute?
Isotonic
What is the isotonicity for all solutes? (Range and the “rough” #)
280-296, or 300 mOsm
What % of NaCl is isotonic in plasma?
0.9%
What % of glucose is isotonic in plasma?
5.0%
If your liver fails, how will this effect your blood?
There will be a drop in protein production, making the blood hypotonic
What is ascites?
Severe abdominal edema
What is the disease known for giving starving people “pot bellies”?
Kwashiorkor
Total volume of blood in a female vs a male?
Female: 5L
Male: 6L
What is the measure of the contribution over 2,000 plasma proteins make to the total osmolarity of the blood?
Osmotic pressure, or Colloid osmotic pressure (COP)
What are the plasma cell leukocytes that make antibodies?
B Lymphocytes
What are the two main types of lipids in the blood?
Triglycerides and phospholipids
What do triglycerides want the plasma levels to be?
<150 mg/dL
What do phospholipids want the plasma levels to be?
160-300 mg/dL
Where are phospholipids found?
Cell membrane
What do phospholipids tend to form?
Bilayers, due to having both hydrophobic and hydrophilic properties
What term means phospholipids have both hydrophilic and hydrophobic properties?
Amphiphilic/amphipathic
What part of the phospholipid is water soluble?
Fatty acid heads
What part of the phospholipid is fat soluble?
Fatty acid tails
What part of the phospholipid is polar?
Fatty acid heads
What part of the phospholipid is nonpolar?
Fatty acid tails
What part of the phospholipid is hydrophobic?
Fatty acid tails
What part of the phospholipid is hydrophilic?
Fatty acid heads
What part of the phospholipid is lipophobic?
Fatty acid heads
What part of the phospholipid is lipophilic?
Fatty acid tails
Which part of the phospholipid crosses membranes readily?
Fatty acid tails
Which part of the phospholipid does NOT cross membranes readily?
Fatty acid heads
Which part of the phospholipid breaks off to form prostaglandins?
Fatty acid tails
What does cholesterol want the plasma level to be?
<180 mg/dL or <200 mg/dL
What % cholesterol is made by the liver? What % is diet?
85% genetic
15% diet
Where are lipoproteins produced?
Liver
What do lipoproteins do?
Transport lipids in the blood
Which one is “bad” cholesterol?
Low density-lipoproteins (LDLs)
How much LDLs should a normal patient have?
<100 mg/dL
How much LDLs should high risk patients have?
<70 mg/dL
What diseases are correlated with high LDLs?
Coronary artery disease and atherosclerosis
What process do LDLs use to transport lipids into the cells?
Receptor mediated endocytosis
What is the process o receptor mediated endocytosis?
When an LDL binds to an LDL receptor on a cell wall, it opens allowing cholesterol to enter the cell
What happens when there’s too much LDL?
It gets under the endothelium, causes inflammation, and plaque builds up
What protein is part of the LDL that attaches to receptors found on most cells?
Apoprotein B100
What does apoprotein B100 do once inside the cell?
Metabolizes cholesterol
What can destroy LDLs?
Scavenger macrophages
What is arteriosclerosis?
Loss of elasticity of arterial wall (“hardening of the arteries”)
What is atherosclerosis?
A type of arteriosclerosis, where there’s clogging of the arteries (with plaque)
What is the plaque in atherosclerosis made of?
Lipids (such as cholesterol), WBC (such as macrophages), aberrant smooth muscle cells, and calcium
What can excess plaque in arteries cause?
The artery may rupture, causing hemorrhage
What part of atherosclerosis may cause a stroke?
Clots that form after an arterial rupture block O2 from going to the brain
What is familial hypercholesterolemia?
A genetic mutation in LDL receptors that prevent cholesterol from entering cells (so it stays in the plasma)
Are there high levels of cholesterol in familial hypercholesterolemia?
There are high levels of cholesterol in the blood, causing catastrophic arterial clogging
Does familial hypercholesterolemia only effect old people who eat like shit?
No, it’s genetic and young people suffer from it
What is “good” cholesterol?
High density lipoproteins (HDLs)
What do you want your HDLs to be at?
> 30 mm/dL
What is a normal range of HDLs?
30-80 mm/dL
What can an HDL of >60 mm/dL do?
Protect against heart disease
What do HDLs do?
Take cholesterol from the cells to the liver, where it will be a component of bile and excreted in feces
What is the movement of HDLs?
Receptor mediated endocytosis
What are normal blood glucose values?
70-110 mg/dL
Where is glucose stored in the body?
In the muscles and liver as glycogen
What makes glycogen go into the blood?
Glucagon
How many erythrocytes in a female vs male?
Female: 4.5 million/μL
Male: 5.5 million/μL
What is the diameter of erythrocytes?
7.5 μm
How long do erythrocytes last?
120 days
What removes erythrocytes at the end of their lifespan?
The spleen
What protein in blood carries O2?
Hemoglobin
How many hemoglobin molecules per erythrocyte cell?
280 million molecules
How much total hemoglobin in females vs males?
Females: 12-16 g/dL
Males: 13-18 g/dL
How many polypeptide chains does hemoglobin have?
4
What are the polypeptide chains hemoglobin has?
2 Alpha chains
2 Beta chains
How many hemes do each chain in hemoglobin have?
1 heme for each chain
How many hemes in 1 hemoglobin moloecule?
4
How many iron molecules does each heme have?
1 iron for each heme
How many irons in 1 hemoglobin molecule?
4
How many oxygens do each iron carry?
1
How many oxygens in each hemoglobin molecule?
4
What is the green pigment when hemoglobin breaks down?
Biliverdin
What is the yellow pigment made and released when hemoglobin is degraded by macrophages?
Bilirubin
What does the liver convert bilirubin into?
Bile components
Where do bile components go?
Secreted into the intestines
What is urobilinogen?
A by-product from bile degredation
What is the pigment from urobilinogen that gives feces a brown color?
Stercobilin
What is a yellow covering of skin/eyes due to excess bilirubin?
Jaundice
What causes jaundice?
Liver disease
What is the difference between oxyhemoglobin and deoxyhemoglobin?
Oxy: hemoglobin bound to O2
Deoxy: hemoglobin WITHOUT O2
What is carbaminohemoglobin?
Hemoglobin bound to CO2
What is hemoglobin bound to carbon monoxide?
Carboxyhemoglobin
What does hematocrit mean?
The % of centrifuged RBCs in blood
What’s a normal hematocrit in a female vs a male?
Female: 42%
Male: 47%
What does a high hematocrit % mean?
Infection
What does a low hematocrit % mean?
Heart and/or blood disorders
How do you calculate sedimentation (Sed) rate?
Measure the time required for RBCs to settle to the bottom of a tube containing a specific fluid
What does Sed rate tell you?
RBC density
What increases Sed rate/RBC density?
Pregnancy, disease (anemia, inflammation)
After 120, what happens to RBCs?
They become brittle and squeeze through holes in the spleen, causing them to rupture. They are then removed by macrophages
What is an RBC rupture called?
Hemolysis
Where does hemoglobin go when RBCs rupture?
It spills into the blood
What is hemopoiesis/hematopoiesis?
Blood formation within red bone marrow
What first makes the blood cells in humans?
The yolk sac in the embryo
When does the yolk sac make blood cells?
3-7 weeks of gestation
What are the precursor blood cells?
Hemopoietic stem cells
Where do hemopoietic stem cells migrate to and from?
Hemopoietic stem cells travel from the yolk sac to the embryo
What makes blood after the yolk sac?
Liver, spleen, and lymphatic tissues
When do the liver, spleen, and lymphatic tissues make blood?
At the end of the 2nd trimester or beginning o the 3rd
When does the liver stop making blood cells?
Birth
What type of blood cells do the spleen and lymphoid tissues continue to make?
Lymphocytes (a type of leukocyte)
What is it called when blood is made outside the medullary cavity?
Extramedullary hemopoiesis
Is extramedullary hemopoiesis normal?
No, in birthed humans this indicates loss of bone marrow function, possibly due to cancer, toxins, and radiation
Where does medullary hemopoiesis take place, and what is it called?
Red bone marrow occurs in the bone marrow cavity
When is red bone marrow in all bones?
From late fetal life until about 5 years old
What bones have red bone marrow after childhood? At what age?
Membranous bones by the age of 20
What are examples of membranous bones?
Sternum, ilium, vertebrae, ribs
What hormone from the liver and kidneys regulates erythropoiesis?
Erythropoietin (EPO)
What is erythropoiesis?
Production of erythrocytes
Why would you need more O2? (And subsequently, more erythrocytes)
Hemorrhaging, long term anemia, pulmonary/respiratory disease, living in high altitudes
What is natural “blood doping”?
Training in high altitudes where you get more EPO, which increases RBCs, which increases endurance
What element is used to make hemoglobin?
Iron
What is most of the body’s iron used for?
In hemoglobin
Is iron safe by itself?
No, it’s toxic, so it has to be bound to proteins
What is the primary extracellular protein that transports iron within the blood and makes iron available to cells (with the help of 2 other proteins)?
Transferrin
What are the 2 proteins that help transferrin make iron available to cells?
Ferritin and hemosiderin
Are ferritin and hemosiderin extracellular or intracellular proteins?
Intracellular proteins
What are the dietary iron ions?
Fe+2 and Fe+3
What form of iron can the intestines absorb?
Fe+2
What converts iron ions from Fe+3 to Fe+2 so it can be absorbed by the intestines?
The stomach
Where is vitamin B12 found?
Meat, brewers yeast
Why is vitamin B12 necessary?
DNA production and cell division
What is “intrinsic factor”?
A protein produced in the stomach that allows intestines to absorb B12
What pathology can be caused by failure to absorb B12?
Pernicious anemia
What are other names for folic acid?
Folate or folacin
Where can you get folate?
Dark leafy greens and beans
What is the purpose of folate?
DNA production and cell division
What pathology are folate deficiencies linked to?
Neural tube defects
What protein is used to diagnose NTD?
Elevated alpha fetal proteins
Where can you test the fetus for NTDs?
The maternal plasma
Does folate build up fast?
No, mothers should take folate prenatal vitamins months prior to being pregnant
What happens normally to the neural groove?
It closes to become the neural tube, or the beginning of the nervous system
When does the neural tube form/the neural groove close?
Days 9-22 of gestation
What NTD is the worst?
Anencephaly, a total lack of forebrain
Is anencephaly an anterior or posterior NTD?
Anterior
What are the posterior NTD from best to worst prognosis?
Spina bifida occulta
Meningocele
Myelomeningocele
What is the process leukocytes use to leave the blood vessels into the interstitum?
Diapedesis
What is the method of locomotion used by leukocytes to move within the interstitium?
Amoeboid movement
What is the process which leukocytes are attracted to locations by following the “scent” of chemicals?
Chemotaxis
What are organelles found in neutrophils which function as the body’s detoxifiers? (Found in the liver)
Peroxisomes
What are organelles found in various cells such as neutrophils that are the cells digestive system?
Lysosomes
What is the nonfunctional “drumsticks” seen on XX chromosomes?
Barr body
What does it mean if you find WBCs on a crime scene with drumsticks?
The blood is from a female
What WBC have barr bodies/drumsticks?
Neutrophils
What is the range of leukocytes in blood?
4,800-10,800 /µL
What type of leukocytes have granules and lobed nuclei?
Granulocytes or polymorphonuclear leukocytes
What are the most abundant WBC and what is their range?
Neutrophils: 2,500-8,000 /µL
What are neutrophil’s roles?
Primary phagocyte and inflammatory cell, dies to make pus
What % of WBC are neutrophils?
50-70%
What color are neutrophil’s cytoplasm and how many lobes does it have?
Clear, 3-6 lobes
What are antimicrobial compounds which digest holes in microbes?
Denfensins
What % of WBC are eosinophils?
2-4%
What color are eosinophil’s cytoplasm? How many lobes?
Red-pink, 2 lobes
What is the normal range of eosinophils?
<500/µL
When are eosinophil levels elevated?
During allergic reactions and parasitic worm infections
What % of WBC are basophils?
<1%
What is the normal range for basophils?
50-100/µL
What color are basophils?
Dark purple/blue
What are basophils role?
Produce histamine and heparin for anticlotting and inflammation during allergic reactions
What leukocytes are granulocytes or polymorphonuclear leukocytes?
Neutrophils
Eosinophils
Basophils
What type of leukocytes don’t have granules?
Agranulocytes or mononuclear leukocytes
What % of WBCs are lymphocytes?
25%
What is the normal range of lymphocytes?
1,000-4,500/µL
What do lymphocytes look like?
Small, dark purple, and round. Small crescent of cytoplasm
How big are lymphocytes?
As big as RBCs (7µm)
What % of WBCs are monocytes?
3-8%
What is the normal range of monocytes?
100-700 /µL
What do monocytes look like?
Large cells with abundant cytoplasm. Horseshoe shaped nuclei that is larger than other WBCs
What leukocytes become macrophages after diapedesis?
Monocytes
What leukocytes are agranulocytes or mononuclear leukocytes?
Lymphocytes
Monocytes
How many platelets are in the blood?
150,000-400,000 / µL
What are platelets?
Cell fragments that initate blood clotting
What do platelets come from?
Megakaryocytes
What hormone regulates the formation of platelets?
Thrombopoietin
What produces thrombopoietin?
Liver and kidneys
What is the body’s process for stopping bleeding called?
Hemostasis
What is the first step in hemostasis?
Vascular spasms
What are vascular spasms?
Vasoconstriction of blood vessels following damage
What is the second step of hemostasis, following vascular spasms?
Platelet plug formation
What is blood exposed to when there is damage to a blood vessel?
Collagen
What helps platelets aggregate on the collagen?
Von Willebrand factor (VWF)
What do platelets release on the collagen when you’re cut?
Serotonin, ADP, and thromboxane A2
What does thromboxane A2 do?
Keeps more platelets coming to the damaged site
What keeps platelets from adhering to undamaged endothelium?
Prostacyclin
What is the third step of hemostasis, which occurs after platelet plug formation?
Coagulation or blood clotting
How many clotting factors are involved in blood clotting?
13
What vitamin is necessary for clotting factors 2, 7, 9, 10?
Vitamin K
What is an anticoagulant that blocks the effect of vitamin K?
Coumadin (Warfarin)
What is the coumadin (warfarin) a main ingredient in?
May rat poisons
What is an anticoagulant that inhibits thrombin and clotting factor X (10)?
Heparin
What blocks the production of thromboxane A2 and prostaglandins?
Aspirin
What is the fourth step in hemostasis, after coagulation?
Prothrombin activator activates prothrombin
What does prothrombin change into?
The enzyme thrombin
What causes fibrinogen to form long strands of fibrin?
Thrombin
What does fibrin do?
Glue the platelets together to form the basis of the blood clot
What are blood types based off of?
The type of carbohydrate-protein (glycoprotein) on the outside of the erythrocyte’s membrane
What are the glycoproteins that determine your blood type called?
Antigens
What are the antibodies you are born with that attack the blood types you don’t have?
Agglutinins
If you have type A antigens, you have___ antibodies?
Anti-B
If you have type B antigens, you have___ antibodies?
Anti-A
If you have type A and B antigens, you have___ antibodies?
No antibodies against A or B
What is the universal recipient?
Type AB+
If you have type O, you have 0 antigens and anti-___?
No antigens and anti-A and anti-B antibodies
Why is O+ the universal donor?
It has no antigens so everyone can have it without attacking it
What is the Rh or Rhesus group?
The + or - that comes from having an Rh glycoprotein on your cell membrane
What did Type O and the Rh group used to be known as?
Types C and D
For the general US population, what % are: O
48%
For the general US population, what % are: A
32%
For the general US population, what % are: B
16%
For the general US population, what % are: AB
4%
What does idiopathic mean?
Of unknown origins
What does exacerbate vs ameliorate mean?
To make worse vs to make better
What is ablation?
To remove as with surgery
What is it called when you have elevated WBCs?
Leukocytosis
What is it called when you have reduced WBCs?
Leukocytopenia
What is it called when you have reduced levels of platelets?
Thrombocytopenia
What is pancytopenia?
Reduction of all blood cells
When is pancytopenia seen?
With bone marrow destruction from radiation
Reduction in RBCs vs WBCs cause what problems?
RBC: anemia
WBC: immuno suppressed
Reduction in platelets causes what problem?
Impaired blood clotting
What is an iatrogenic condition?
Caused by a clinician (ex. leaving forceps in the abdomen)
What is a nosocomial condition?
Contracted in the hospital
What is it called when there’s elevated RBCs?
Polycythemia
What color does the skin turn with polycythemia?
Pink
What causes polycythemia?
Respiratory diseases, long term anemias, smoking, living in high altitudes
What is the most common form of hemophilia?
Hemophilia A
What causes hemophilia A?
A mutation in the gene for clotting factor 8
Is hemophilia A X or Y linked?
X
What is it called when there’s too much iron stored as ferritin?
Hemosiderosis
What is the medical term for iron overload?
Hemochromatosis
What causes iron overload?
Genetics, hemolytic anemia, liver disease
What are symptoms of hemochromatosis?
Damage to liver, heart, and pancreas
What can damage to the pancreas from hemochromatosis lead to?
Diabetes mellitus (loss of insulin production)
What color might the skin turn in iron overload?
Bronze
What is the condition where there’s a decrease in RBCs or hemoglobin, or an abnormal oxygen carrying capacity?
Anemia
What type of anemia is from vitamin B12 deficiency?
Pernicious Anemia (PA)
Symptoms of pernicious anemia?
Weakness, sore tongue, tingling extremities, neuropathy
What causes folate deficiency anemia?
Diet, alcohol abuse, infection, and drugs
What are the symptoms of folate deficiency anemia?
Weight loss, intense weakness, tingling, skin lesions, hepatic disease
What % of adults have iron deficiency anemia?
10-30%
What causes iron deficiency anemia?
Diet and hemorrhage
What are symptoms of iron deficiency anemia?
Weakness, sore tongue
Where does sickle cell anemia take place in the hemoglobin chain?
The #6 amino acid of the beta hemoglobin chain
What type of mutation occurs in sickle cell anemia?
Point mutation
What is point mutation?
Only one base pair on the gene is switched
What base pair is mutated in sickle cell anemia?
Glutamate is replaced by valine
What deforms the RBCs in sickle cell anemia?
Hemoglobin S (when O2 is low) forms long fibrous polymers which deform the RBCs
What is a complication in sickle cell anemia where there is blockage of small blood vessels?
Vaso-occlusive crisis
What happens in sickle cell disease?
Episodes of hypoxic injury (ischemia), and infarction or necrosis
What is one beneficial(?) outcome for sickle cell patients?
They are less likely to get malaria as they create a cellular environment that is unwelcoming to the virus
What is seen in chronic hemolytic anemia?
Seizure, stroke, pallor of skin
What disease is similar to sickle cell anemia?
Thalassemia
Where does alpha thalassemia occur?
Asian nations
Where does beta thalassemia occur?
Mediterranean nations
What are symptoms of thalassemia?
Edema, ascites, CHF, hepato/cardio/spelomegaly
What is aplastic anemia?
The inability to synthesize blood cells in bone marrow
What causes aplastic anemia?
Toxins/drugs, radiation sickness
What type of anemia is “bleeding out”?
Hemorrhagic anemia
What type of anemia is from RBC ruptures (hemolysis)?
Hemolytic anemia
What can cause hemolytic anemia?
Transfusion miss-match, toxins/drugs, radiation
What is the “kissing disease”?
Mononucleosis
What causes mono?
Epstein-Barr virus (EBV)
What are symptoms of mono?
Enlarged lymphocytes, lethargy sore throat
What is lymphadenopathy?
Swollen lymph nodes, especially around the neck
What happens in disseminated intravascular coagulation (DIC)?
Widespread clotting, imminently life threatening
What can cause DIC?
Septicemia, blood transfusion rejections
What is erythroblastosis fetalis?
Hemolytic disease of the newborn, where the mother is Rh-, but the father and fetus are Rh+
What happens in erythroblastosis fetalis?
The mother makes antibodies against Rh factor (which is in the baby’s blood)
Is the fetus at risk in erythroblastosis fetalis?
No, as the antibodies are not formed for at least 6 weeks after exposure, which usually occurs during labor. It is the next fetus who is in danger
What is the treatment for erythroblastosis fetalis?
Give the mother RhoGAM to prevent her immune system from attacking Rh+ cells
What is leukemia?
Neoplasm of leukocytes, where there are increased #s and decreased immune function
What causes leukemia?
Genetics, radiation, viruses, drugs
How do you treat leukemia?
Chemo, bone marrow transplants, radiotherapy
What is acute leukemia?
Undifferentiated cells never mature
What is chronic leukemia?
Cells may mature, but remain dysfunctional
Which form of leukemia has a poor prognosis?
Acute leukemia
Which leukemia has a gradual onset of symptoms?
Chronic leukemia
What is cachexia? When is it seen?
Wasting, as seen in acute leukemia
Where does myelogenic leukemia come from?
Cells giving rise to neutrophils, basophils, and eosinophils
What causes myelogenic leukemia?
Large doses of radiation
What type of leukemia can come from high doses of chemotherapy?
Acute myelogenic leukemia
What age group is chronic myelogenic leukemia usually seen in?
Adults
What age group is acute lymphoblastic leukemia usually seen in?
Pediatrics
What are symptoms of acute lymphoblastic leukemia?
Splenomegaly, hepatomegaly, lymphadenopathy
What type of leukemia specifically occurs in adults over 50?
Chronic lymphoblastic leukemia
What is a myeloma?
Neoplasm of plasma cells in bone marrow, where you can seen tumors in bone
What is the most common symptom of myelomas?
Bone pain
What causes myelomas?
Bone resorption and hypercalcemia
What is the cancer of lymphocytes in lymphatic tissues?
Lymphomas
What are symptoms of lymphomas?
Enlarged lymphatic tissues, painless masses, fever, weight loss, night sweats, compromised immune system
What type of lymphoma has a malignancy of mature B cells?
Hodgkin’s lymphoma
What are risk factors for Hodgkin’s lymphoma?
Epstein-Barr virus, genetics
What % of lymphomas are non-Hodgkin’s?
90%
What is malignant in non-Hodgkin’s lymphoma?
T or B lymphocytes
What are risk factors for non-Hodgkin’s?
Autoimmune disorders, HIV, pesticides
What a possible danger in non-Hodgkin’s?
Blood can become dangerously thickened/viscous
What does the lymphatic system do?
Regulates fluid balance
What % of ECM fluid do the lymphatic vessels take up?
10%
Where do the lymphatic vessels return ECM to?
The blood stream
What happens if lymphatic vessels are clogged?
Elephantiasis
What is the largest lymphatic vessel collecting lymph from the body and returning it to the blood?
Thoracic duct
Where does the thoracic duct return lymph via?
The left subclavian vein between the internal and external jugular veins
What is lymph?
Lymphatic vessel fluid
What are lymphoid tissues sites for?
Lymphocyte proliferation and maturation
What do immune cells monitor for?
The presence of pathogens
What are examples of lymphatic tissues?
Spleen, thymus, bone marrow, lymph nodes, tonsils
What are diffuse lymphatic tissues?
Lymphatic tissues that are scattered throughout the body
What are the principal lymphoid organs of the body?
Lymph nodes
What do lymph nodes do?
Filter pathogens/infections in lymph that is being returned to the blood
What are lymph nodes hooked up to?
Lymphatic vessels
What are lymph nodes heavily populated by and why?
Macrophages that destroy and present antigens
What do lymphocytes do in the lymph nodes?
Attack against antigens
Do the lymph nodes recycle cells?
Yes
What is the outer portion of the lymph node? What is the inner?
Outer: cortex
Inner: medulla
What does the outer portion of the cortex contain?
Lymphoid follicles (round nodules)
What does the outer portion of the lymphoid follicle contain?
T Lymphocytes
What does the inner portion of the lymphoid follicle contain?
B lymphocytes, which become plasma cells that produce antibodies
What do T lymphocytes do?
Process antigens/pathogens, microbes
What is the inner portion of the lymphoid follicle called?
Germinal centers
What does the medulla contain in lymph nodes?
B and T lymphocytes and plasma cells
What are lymphatic tissues found in the walls of intestines (ex. protecting the body from pathogens that enter the body by mouth)
Peyer’s patches
What is vermiform appendix?
An organ that is attached to the beginning of the colon that has abundant diffuse lymphatic tissues in its walls
What is a major site for lymphocyte proliferation?
Spleen
What is a major site for removal of dead/dying RBCs and WBCs?
Spleen
What is the largest lymphoid organ?
Spleen
What lymphatic structure is found in children, but regresses in adults?
Thymus
What is the thymus important for?
Developing T Lymphocytes
What tonsils are on either side of the posterior oral cavity?
Palatine tonsils
Which are the largest tonsils that are most often infected?
Palatine tonsils
What tonsils are at the base of the tongue?
Lingual tonsils
What tonsils are at the posterior wall of the nasopharynx?
Pharyngeal tonsils
What are the pharyngeal tonsils also known as?
Adenoids
What does “Per Os”, or “per ostium” mean?
By mouth
Do water soluble substances cross membranes easily?
No
Do lipid soluble substances cross membranes easily?
Yes
Where do both water soluble and lipid soluble substances start in their journey?
Intestines
Where does water soluble substances go from the intestines?
Intestinal veins
Where do lipid soluble substances go from the intestines?
Intestinal lacteals (lymphatics)
What vein does the intestinal veins carry water soluble substances to?
Superior mesenteric vein
Where do lipid soluble substances go from intestinal lacteals/lymphatics?
Thoracic duct
What is the main lymphatic vessel?
Thoracic duct
Where do water solubles go from superior mesenteric vein?
Hepatoportal vein (to the liver)
Where do fat solubles go from the thoracic duct?
Left subclavian vein
Where is the left subclavian vein? (What is it in between)
In between the external and internal jugular veins
What in the liver detoxes water solubles?
Hepatic sinusoids
What percent do hepatic sinusoids detox on first pass?
80-90%
What compounds bypass the liver’s detox system on “first pass”?
Lipid/fat solubles
Where do water solubles go from the hepatic sinusoids?
Central vein
Where do water solubles go from the central vein?
Hepatic vein
Where do water solubles go from the hepatic vein?
Inferior vena cava (then back into general circulation)
Which immune system are you born with?
Nonspecific, or innate
What is the first line of defense?
External or anatomical barriers
What are examples of external barriers?
Skin, mucus, oil, sweat, tears, sloughed cells, saliva, wax, urine, gastric acid
What is an enzyme in mucus, tears, and saliva that kills bacteria?
Lysozome
What is the second line of defense?
Inflammation, fever, and cells getting to work
What are leukocytes that phagocytize foreign materials including pathogens?
Phagocytes
Which phagocytes contain bacteria-killing enzymes which make highly reactive Reactive Oxygen Species (ROS) or free radicals?
Neutrophils
What are ROS or free radicals called?
Superoxide radicals
What do superoxide radicals form?
Hydrogen peroxide
What are proteins produced by neutrophils that digest holes in the membranes of microbes?
Defensins
What phagocytes fight allergens and parasitic worms?
Eosinophils
What do basophils release?
Heparin and histamine
What does histamine do?
In response to allergens, causes allergic reactions
What does heparin do?
Prevents clotting (anticoagulant)
What are non-phagocytic lymphocytes that destroy our cells that become cancerous or contain viruses?
Natural killer (NK) cells
What are enzymes that digest holes in cell membranes and cell walls of microbes? (As seen in NK cells)
Perforins
What is genetically programmed cell death called?
Apoptosis
When does apoptosis occur?
Cell completes its function
Mutations make dysfunction or cancer
Cell is stressed
Cell is infected
What do monocytes do in the 2nd line of defense?
Become macrophages (powerful phagocytes)
What cells roam looking for potentially dangerous antigens, then present them to the rest of the immune system for processing?
Monocytes
What are macrophages of the liver?
Kupfer cells
What cells are similar to macrophages, that are found throughout the body where there are external or internal surfaces?
Dendritic cells
Where might you find dendritic cells?
Skin, mucosa of nose, lungs, stomach, intestines
What do dendritic cells do?
Reach out from the protection of tissues to sample the surface for potential threats and present them to the rest of the immune system for processing
What cells are newly described, similar to helper T, cytotoxic T, and NK cells?
Innate lymphoid cells
What do innate lymphoid cells have an important role in?
Inflammation
What can dysregulation of innate lymphoid cells do?
Cause allergies, asthma, and autoimmune diseases
What cells regulate adipose function and metabolic homeostasis?
Innate lymphoid cells
What are innate lymphoid cells classified based on?
Cytokine release (hormones) and transcription factors that control their development
What is the process where a phagocyte engulfs particles such as cells?
Phagocytosis
What is the organelle that is made when podocytes surround a particle and wrap it up in the cell membrane? (“undigested food”)
Phagosome
What organelle is the cell’s digestive system?
Phagosomes
What is the digestive hydrolytic enzymes in phagosomes?
Lysosome
What is a phagosome fused with lysosome called?
Phagolysosome
What is an organelle containing the undigested remains from phagocytosis called?
Residual bodies
What is the process where the undigested remains are expelled from the cell?
Exocytosis
What are toxic chemicals made by phagosomes with extra unpaired electrons that can destroy microbes and our own cells?
Reactive Oxygen Species (ROS) or free radicals
What can ROS’s destroy?
Microbes as well as our own cells and tissues
What is a reactive compound produced by our cells to combat pathogens?
H2O2
Is H2O2 safe?
No, it is potentially damaging to cells and tissues so it must be broken down
What enzymes break down H2O2 into water?
Peroxidase and catalase
What enzyme breaks down the superoxide radical (ROS)?
Superoxide dismutase
Where does superoxide dismutase get released from?
Neutrophils
What turn ROS into H2O2?
Superoxide dismutase
What turns H2O2 into water?
Peroxidase or catalase
What movement is involved in inflammation?
Diapedesis
What is the chemical attraction of WBC to various areas they are needed (such as inflammation, infected areas)?
Chemotaxis
What produced by basophils can cause inflammation?
Bradykinin
What isolates pathogens with an extravascular “clot” and cause inflammation?
Clotting proteins
What hormone proteins regulate immune responses (and inflam.)?
Cytokines
What cytokines from macrophages and lymphocytes stimulate many leukocyte immune responses?
Interleukins
What cytokines are from anti-viral and anti-cancer compounds?
Interferons
What are a series of proteins that destroy any pathogen marked by antibodies (and can sometimes attack pathogens without the antibodies)?
Complement
What is released from basophils and mast cells that prevents blood clost?
Heparin
Why is heparin released to prevent blood clots?
So WBCs can get to the area
What is released from basophils and mast cells that cause inflam?
Histamine and leukotrienes
What are active fatty acids from damaged cells that are hormone like?
Prostaglandins
What produces prostaglandins?
An enzyme called cyclooxygenase
What can inhibit cyclooxgenase?
NSAIDs
What causes most headaches, uterine contractions, menstrual pain, etc?
Prostaglandins
Do ROS and free radicals have a role in inflammation?
Yes
What are characteristics of inflammation?
Redness, swelling, heat, pain
What is leukocytosis?
An increase in the number of WBCs
What does purulent/suppurative mean?
The condition of having pus
Does pus indicate inflammation and infection?
Yes
What causes vasodilation in inflammation?
Bradykinins, histamine, leukotrienes
What is hyperemia?
Increased blood flow to the damaged area caused by vasodilation
What can vasodilation cause?
Erythema or redness
What can increased capillary permeability cause due to the fluid leaking from blood vessels to the ECM?
Edema or swelling
What is exudate?
Fluid of edema or edematous fluid
What type of exudate is a thick and gooey fluid composed of pus?
Purulent or suppurative exudate
What is pus?
Cellular and microbial debris
What type of exudate is thick and gooey and contains blood?
Hemorrhagic exudate
What type of exudate is thick and gooey and contains fibrin or fibinogen?
Fibrous exudate
What type of exudate is thin and watery, as in a blister?
Transudate or serous exudate
What is urticaria?
Raised rash caused by histamine, as seen in jellyfish stings
What is Pruritis?
Itching caused by histamine
What causes increased mucus production?
Histamine
What causes the pain in inflammation?
Bradykinin, histamine, prostaglandins
What is febrile or pyrexia?
Having a fever caused by interleukin-1
What is a pyrogen?
A compound that causes a fever
Is interleukin-1 a pyrogen?
Yes
Are cytokine storm and cytokine release syndrome life-threatening?
Yes
What levels are elevated in cytokine storm?
Inflammatory cytokines and immune-cell hyperactivation
What triggers cytokine storm?
Therapies, pathogens, cancer, autoimmune conditions, influenza, COVID
What are symptoms of cytokine storm?
Cytokine induced tissue damage and multiple organ failure
How do NSAIDs treat inflammation?
Reduce prostaglandins by inhibiting cyclooxygenase
What are ibuprofen, aspirin, naproxen, and indomethacin examples of?
NSAIDs
Is acetaminophen an NSAID?
No
What are SAIDs?
Steroidal anti-a=inflammatory drugs
How do SAIDs treat inflam?
Prevent lysosomes of WBCs from releasing enzymes
How do decongestants treat inflammation?
Cause vasoconstriction (like epi or norepi) allowing lymphatic drainage to reduce swelling
How do anti-histamines treat inflam?
Prevent the effects of histamines
What is the immune system you are NOT born with?
Specific or adaptive immune system
What is the third line of defense?
Specific or adaptive immune system
What is the specific or adaptive immune system composed of?
Cells and antibodies (humoral immunity) and various T lymphocyte functions (cellular immunity)
What is an antigen?
Foreign compounds that (usually) promote an immune response
They are “non self”
What is an epitope or antigenic determinants?
The part of an antigen that stimulates the immune response
Can an antigen have multiple epitopes?
Yes!
What is hapten?
Not an antigenic by themselves, but when combined with other proteins, they become antigenic
What are examples of hapten?
Penicillin, poison ivy, monosodium glutamate, animal dander
What part of an antigen is presented to the MHC?
Epitopes or antigenic determinants
Are antigen presenting cells innate or adaptive or both?
Both!
Macrophages and dendritic cells are innate
B lymphocytes are adaptive
Where do antigen presenting cells present the partially digested antigen to?
The cell membrane so the whole rest of the immune system can see it
What are major histocompatibility complex (MHC) and Human leukocyte antigens (HLA)?
Proteins on the cell membrane of the antigen presenting cells that help present the antigen and identify self vs non-self
What do APCs phagocytize?
Antigens
When APCs place part of the antigen on the membrane with the MHCs, what do they show it to?
Helper T lymphocytes
Which MHC is found on every nucleated cell in the body and platelets?
MHC-1
Which MHC presents intracellular or endogenous antigens?
MHC-1
What are viruses and “neoantigens” produced by mutations in cancer cells examples of?
Endogenous antigens
What cells recognize MHC-1?
CD8 cells (Cytotoxic T lymphocytes)
Which MHC is found on APCs?
MHC-2
Which MHC presents extracellular or exogenous antigens?
MHC-2
What cells recognize MHC-2?
CD4 cells (Helper T lymphocytes)
What do CD4 and CD8 refer to?
The type of receptor protein that can bind to or recognize the MHC
Which T lymphocytes are involved in “specific resistance”?
Helper T lymphocytes CD4 cells
What do the Helper T lymphocytes do once they’re “taught” the bad guy’s identity by the APC?
The Helper T clones itself thousands of times carrying the bad guy’s identity
What is triggered when CD4 binds to the MHC-2 protein on an APC?
The CD4 triggers apoptosis to kill the infected cell
What do cytotoxic T lymphocytes (CD8 cells) do once told be helper T cell the antigen’s identity?
They “seek and destroy” the antigen by docking with diseased cells and injecting lethal chemicals
What do these chemicals released by cytotoxic T lymphocytes do?
Perforins
Punch holes in microbes
What do these chemicals released by cytotoxic T lymphocytes do?
Lymphotoxin
Destroys the foreign target cell’s DNA
What do these chemicals released by cytotoxic T lymphocytes do?
Tumor necrosis factor (TNF)
Destroys cancer cells
What do these chemicals released by cytotoxic T lymphocytes do?
Interferon
Works against viruses
What do these chemicals released by cytotoxic T lymphocytes do?
Interleukins
Induces fever
What T lymphocytes are the “cheerleaders” that keep the system activated/fired up as long as the threat remains?
Inducer T lymphocytes
What T lymphocytes turn the immune system OFF from the specific threat?
Regulator or suppressor T lymphocytes (T regs)
What cells remember the identification of the antigen in case of future exposures and allow for a faster response? (Often before the patient feels sick!)
Memory cells
What lymphocytes mature to become plasma cells that produce antibodies?
B lymphocytes
What is the humoral immune response tasked with?
The production of antibodies
Which antibody (immunoglobulin) is: found in secretions (milk, tears, sweat, etc.)
IgA
Which antibody (immunoglobulin) is:
B cell receptors that bind to antigens…Lower concentrations found
IgD
Which antibody (immunoglobulin) is:
Found in tonsils, skin, mucus membranes?
IgE
Which antibody (immunoglobulin) causes basophils and mast cells to release histamine to cause an allergic reaction?
IgE
Which antibody (immunoglobulin) is:
The first antibodies produced against pathogens and will be replaced by the IgG’s?
IgM
Which antibody (immunoglobulin) is: the most abundant antibodies, the only antibodies that cross the placenta to bring mom’s immunity to the fetus and stimulates complement when bound to antigens?
IgG
What is the marking of an antigen for destruction by the immune system called?
Opsonization
What antibodies attach to pathogen, what destroys it?
Complement
What is a tissue transfer within the same individual called?
Autograft/autotransplant
What is a tissue transfer to an identical twin?
Isograft
What is a tissue transfer to the same species?
Allograft/homograft
What is a tissue transfer to different species?
Xenograft/heterograft
Do isografts with identical twins usually have rejections?
No
Do allografts with fraternal twins have rejections?
Sometimes, if the tissues are not matched
What are drugs that lower the immune system to lower the risk of rejection of tissue transplant?
Immuno-supressants
What is hypersensitivity in regards to the immune system?
A harmful immune reaction to antigens that do not usually cause this sort of reaction
What happens in allergic reactions?
T lymphocytes cause B lymphocytes to produce IgEs, which cause mast cells and basophils to release histamine (and cause an allergic reaction)
What is anaphylaxis?
Very fast and severe systemic reaction with swelling, mucus, bronchodilation, dyspnea, possible sudden death with heart attack
What can treat anaphylaxis?
Epinephrine (adrenalin) injections
What is delayed hypersensitivity?
Takes 12-72 hours to have a harmful immune reaction
When might you see delayed hypersensitivity?
Poison ivy, transplant rejections
What is the most common chronic illness of children?
Asthma
What causes asthma?
Allergens cause plasma cells to produce IgEs, stimulating the mast cells to produce histamine
Which disease is seen in children with severely suppressed immune systems (bubble boy)
Severe combined immunodeficiency disease
What disease comes from a loss of helper T cells that results in a loss of immune system and death by opportunistic diseases?
AIDS
What is a cancer of B lymphocytes resulting in immuno-compromised patients?
Hodgkin’s disease (lymphoma)
How many types of autoimmune diseases are there?
Over 80
Which autoimmune disease has:
antibodies against the ach receptors at the NMJ?
Myasthenia Gravis
What type of paralysis is seen in Myasthenia Gravis?
Flaccid paralysis
Which autoimmune disease has:
Antibodies against DNA/RNA and can effect many cell types
Systemic lupus erythematosus (SLE)
Which autoimmune disease has:
antibodies against the myelin sheath destroying neurons
Multiple sclerosis
Which autoimmune disease has:
Antibodies against the joint cartilages
Rheumatoid arthritis
Which autoimmune disease has:
Hyperthyroidism
Graves disease
Which autoimmune disease has:
Antibodies against beta cells that make insulin?
Diabetes mellitus type 1
Which autoimmune disease has:
Antibodies against insulin receptors, therefore, insulin resistant
Diabetes mellitus type 2
Which autoimmune disease has:
Chronic inflammation of small and large intestines
Inflammatory bowel diseases
Which autoimmune disease has:
Reaction to gluten
Celiac disease
What is the respiratory system lined with all the way down to the terminal bronchioles?
Pseudostratified ciliated columnar epithelium
Does gas exchange occur with Pseudostratified ciliated columnar epi?
Nope
What part of the respiratory tract contains the: nose, pharynx, larynx, trachea down to vocal folds
Upper respiratory tract
What is the purpose of the upper respiratory tract?
Warm and moisten air, filter, olfaction, vocalization
What part of the respiratory tract contains vocal folds to alveoli?
Lower respiratory tract
What are the respiratory bronchioles to the alveoli lined with and why?
Simple squamous epi for gas exchange
How do lungs: gas exhange
O2 in CO2 out
Where does gas exchange occur in the lungs?
Respiratory bronchioles and alveoli
How do lungs: buffer
lungs help regulate pH
How do lungs: participate in the endocrine system
Produces angiotensin 2
How do lungs: participate in allergic reactions?
Mast cells, like basophils, release histamine to cause reactions and asthma
What are the phagocytic cells of the lungs?
Macrophages
How big are alveoli?
0.2-0.5mm diameter
70m2 surface area
What are type 1 cells in the lungs made of, %, and function?
Simple squamous, 95%, make up the walls
What are type 2 cells in the lungs made of, %, and function?
Cuboidal, 5% of alveolar cells, produce surfactant
What does surfactant do?
Reduces surface tension of water making it easier to inhale
What are all the pleura made of?
Simple squamous epi
Which pleura: lines the thoracic wall
Parietal pleura
Which pleura: adheres to the lungs
Visceral pleura
What is the space between two pleura?
Pleural cavity
What kind of pressure in the pleural cavity allows you to inhale?
Negative pressure
What is intrapulmonary pressure?
Pressure in the alveoli, close to atmospheric pressure
What is intrapleural pressure?
Pressure within the pleural cavity
Which is lower:
Intrapulmonary pressure or intrapleural pressure?
Intrapleural pressure is ALWAYS lower than intrapulmonary
What is Boyle’s law?
With a constant temperature, volume and pressure vary inversely
With Boyle’s law: if you increase volume, like when the diaphragm drops as it contracts, what does this do to pressure?
Pressure decreases
Where does AP travel down in inhalation/exhalation?
Phrenic nerve
When the diaphragm contracts, it pulls downwards to _____ volume of intrapleural space, causing a ____ in its pressure
When the diaphragm contracts, it pulls downwards to INCREASE volume of intrapleural space, causing a DROP in its pressure
What is the major inspiratory muscle at rest?
The diaphragm
What is quiet breathing?
Exhalation at rest, accomplished passively (no muscles work, the lungs just collapse)
When are accessory muscles required for inhalation/exhalation?
Forced breathing (like during exercise)
What is 1 atmosphere of pressure at sea level?
760 mm Hg
With intrapulmonary or alveolar pressure, inspiration and expiration pressure changes are what?
Inspiration: -1 mm Hg
Exhalation: +1 mm Hg
With Intrapleural pressure, inspiration and expiration pressure changes are what?
Inspiration: -6 mm Hg
Exhalation: -3 mm Hg
Which is lower, especially during inspiration: intrapleural pressure or intrapulmonary pressure?
Intrapleural pressure is LOWER
What does the volume of breath represent?
Tidal volume
How thick is the respiratory membrane?
0.5 µm
What is the combined surface area of the respiratory membrane’s capillaries?
100 m2
What is the first layer of the respiratory membrane (closest to alveolus)?
Fluid lining alveoli
What layer after the fluid lining alveoli?
Epithelium for alveoli (simple squamous)
What layer after the epithelium?
Basement membrane for alveolar epi
What layer after the basement membrane for alveolar epi?
Interstitum
Is the interstitium thick or thin? What is it made out of?
Thin connective tissue
What layer after the interstitium?
Basement membrane for capillary endothelium
What layer after the basement membrane for the capillary endothelium?
Capillary endothelium
What is the capillary endothelium made out of?
Simple squamous epi
How much blood do the capillaries contain?
120 mL
What happens if you decrease the # of capillaries in the lungs due to diseases such as cancer and emphysema?
You decrease the body’s ability to get O2 in and CO2 out
What is the systemic circulatory system?
Sends blood from lungs to body and back
What is the pulmonary circulatory system?
Blood enters the lungs to pick up O2 and release CO2, then back out to the systemic system
What is the bronchial circulatory system?
Provides oxygenated blood to the tissues of the lungs
Where does the bronchial circulatory system get blood from and return blood to?
Feeds from the aorta and returns blood to the pulmonary veins
What proportion of collapsing forces is the elastic forces of the lungs?
1/3
What proportion of the collapsing forces is the surface tension of water?
2/3
What does the “collapsing forces of the lungs” mean?
What allows exhalation/expiration
What does the inflating forces of the lungs mean?
Allows inhalation/inspiration
Is surfactant like a detergent?
Yes
What creates negative intrapleural pressure?
The contraction of the diaphragm and creating reduced intrapleural pressure
What innervates the diaphragm?
The phrenic nerve
What is measuring volumes and capacities via pulmonary function tests to see how the lungs are working?
Spirometry
What is the tidal volume?
Amount in or out in 1 normal breath
What is normal tidal volume?
500 mL
What is inspiratory reserve volume (IRV)?
Max amount inhaled beyond tidal
What is expiratory reserve volume (ERV)?
Max amount exhaled beyond tidal
What is residual volume (RV)?
Amount in lungs after max exhalation
What are respiratory capacities?
Two or more volumes combined
What is vital capacity?
Max amount exhaled after max inhalation
What is a normal vital capacity?
4800 mL
What is inspiratory capacity?
Tidal + IRV (max amount inhaled after tidal expiration)
What is functional residual capacity (FRC)?
Expiratory reserve volume + residual volume
What is a normal total lung capacity?
6,000 mL
What can increases in total lung capacity, functional residual capacity, and residual volume be cased by?
Hyperinflation due to chronic obstructive pulmonary diseases
Tidal volume amount?
500 mL
What is the respiratory or ventilation rate for adults?
12-18 breaths per minute
What is the respiratory or ventilation rate for infants?
40-80 breaths per minute
What is minute ventilation?
Amount air inhaled per minute
What does minute ventilation determine?
Alveolar ventilation rate (AVR)
What is forced vital capacity (FVC)?
Taking a deep breath, and forcibly exhaling maximally as much as possible
What kind of forced vital capacity suggests restricted breathing?
Normal FVC at first, then low values
What do low values of forced vital capacity indicate?
Obstructive disease
What is forced expiratory volume?
% of vital capacity exhaled in 1 second
What is normal forced expiratory volume?
75-85%
What is the forced expiratory ratio?
(Forced Expiratory Volume/Forced Vital Capacity) x 100
How do you calculate alveolar ventilation rate (AVR)?
Tidal volume - dead space
What does alveolar ventilation rate indicate?
Ventilation effectiveness
What is a normal alveolar ventilation rate?
4,200 mL/min
What increases alveolar ventilation rate most efficiently: increasing volume or increasing rate?
Increasing VOLUME increases AVR more efficiently
What demonstrates a marked decrease in alveolar ventilation rate?
Rapid, shallow breathing
What is dead air/space?
Areas where no gas exchange occurs
How much anatomical dead space is there?
~150 mL
What is anatomical dead space lined with?
Pseudostratified ciliated columnar epi
What is alveolar air?
Air that makes it to the alveoli for gas exhange
How much air is alveolar? (Tidal - dead air = __)
500 mL - 150 mL = 350 mL alveolar
What is alveolar dead space?
Physiological or function dead air space if the alveoli are clogged by mucus etc.
What is Dalton’s law of partial pressure?
In a mix of gases, each gas contributes to total pressure or total pressure of mixture (sum = partial pressures of all gases)
Amount of N2 in atmosphere?
78.6%
Amount of O2 in atmo?
20.9%
Amount of water in atmo?
0.46%
Amount of CO2 in atmo?
0.04%
What do higher levels of O2 increase the risk of?
Fire and explosion
When do you see the first signs of hypoxia?
15-19% O2
What % O2 do you see with exertion, associated with impaired coordination and judgement?
12-14%
What % of O2 do you have abnormal fatigue and signs of cyanosis?
10-12%
What % O2 will you lose consciousness without warning?
<12%
What % O2 will you have mental failure?
8-10%
What % O2 will you be unable to move, have a coma in 40 seconds, convulsions, and death?
<10%
What is ventilation?
The amount of gas reaching the alveoli
What is perfusion?
The amount of blood flow in the pulmonary capillaries
What is autoregulation of vessel diameter?
Lungs are able to adjust their perfusion themselves
What will the lungs do if ventilation is low (less O2, hypoxic conditions)?
Hypoxic pulmonary vasoconstriction
If ventilation is low because of a pathology like emphysema, will arterioles constrict or dilate?
Constrict
What will bronchioles do if CO2 is high? (How does it autoregulate)?
Bronchioles dilate to help eliminate CO2
If low O2 and high CO2, what will the veins and bronchioles do?
Vasoconstriction
Bronchodilation
What % of O2 is carried by hemoglobin?
98.5%
What % of O2 is dissolved in plasma?
1.5%
What % CO2 is carried by hemoglobin?
20%
What % CO2 is dissolved in plasma?
7-10%
What is the hemoglobin that carries CO2 called?
Carbaminohemoglobin
How much CO2 is found in the form of carbonic acid or bicarbonate ions?
70%
What enzymes cause CO2 to bind with H2O and is found in the erythrocytes and kidney tubules?
Carbonic anhydrase
What is the chloride shift in TISSUES?
In the tissues, bicarb is exchanged for a chloride ion (Bicarb into plasma, Cl into RBC)
What is the chloride shift in LUNGS?
In the lungs, bicarb is exchanged for a chloride ion (Bicarb into RBC, Cl back out to be exchanged into CO2 and H2O and to be dumped by lungs)
What is Haldane effect?
O2 displaces CO2 from hemoglobin. The higher the PO2, the more O2 on hemoglobin, the less CO2 carried by hemoglobin
What do you want in the lungs: more O2 on hemoglobin or CO2?
More O2, so release CO2
What is the Bohr effect?
The more CO2 and H+, the less O2 carried by hemoglobin
How does the Bohr effect relate to tissues?
In the tissues where there is more CO2 and H+, hemoglobin is more likely to release O2
If O2 is influencing CO2 and H+, what effect is it?
Haldane
If CO2 and H+ are influencing O2, what effect is it?
Bohr
Does this condition cause hemoglobin to pick up/bind to O2?
Lungs: lower H+
PICK UP O2
Does this condition cause hemoglobin to pick up/bind to O2?
Lungs: lower CO2
PICK UP O2
Does this condition cause hemoglobin to pick up/bind to O2?
Lungs: lower temperature
PICK UP O2
Does this condition cause hemoglobin to pick up/bind to O2?
Lungs: lower DPG or BPG)
PICK UP O2
Does this condition cause hemoglobin to pick up/bind to O2?
In the fetus: higher levels of fetal hemoglobin
PICK UP O2 from mom
Does this condition cause hemoglobin to release O2?
Tissues: higher H+
RELEASE O2
Does this condition cause hemoglobin to release O2?
Tissues: higher CO2
RELEASE O2
Does this condition cause hemoglobin to release O2?
Tissues: higher temperature
RELEASE O2
Does this condition cause hemoglobin to release O2?
Tissues: DPG or BPG
RELEASE O2
What causes the lungs to have hemoglobin RELEASE O2 rather than bind to it?
Smoking, lung diseases
At the lungs the hemoglobin will be saturated at what %?
97%
Once O2 is released in the tissues, hemoglobin returns to the heart/lungs in veins, but at rest it is about ___% saturated
75%
What % of O2 is released to the tissues at rest?
22% (97%-75%)
What does 22% O2 equate to in mL?
5 mL O2 per dL plasma
What is the O2 still on the hemoglobin reserved for/what can triple the amount of O2 released?
Exercise
What can exercise bring the O2 released level to?
66% or 15 mL O2/dL plasma
What stimulates inhaling at rest?
Dorsal respiratory group (DRG)
What stimulates forced inhalation and exhalation during exercise/forced respiration?
Ventral respiratory group (VRG)
Where are the dorsal and ventral respiratory groups?
Medulla oblongata
What type of neurons send AP along the phrenic nerve to the diaphragm?
Inspiratory neurons
What type of neurons inhibit the inspiratory neurons to stop the AP from reaching the diaphragm?
Expiratory neurons
What cuts off the dorsal respiratory group allowing us to exhale?
Pneumotaxic center or pontine respiratory center (PRC)
What happens if the pontine respiratory center fails?
The patient inflates the lungs and can only do short expiratory puffs
What controls respiration during vocalization, sleeping, and exercise?
Pontine respiratory center
What keeps the pneumotaxic center functioning? (If this fails, the pneumotaxic center fails)
Apneustic center
What is apneustic breathing?
Inability to fully exhale after damage to PRC
Where are the pnumotaxic center and apneustic center?
Pons
What has the GREATEST OVERALL effect on respiratory rate?
CO2
What has the least significant effect on respiratory rate?
O2
What has the GREATEST DIRECT effect on respiratory rate?
H+
Hypercapnia has the most potent overall effect on _____ ventilation rate and depth
Increasing
What compounds can easily cross the blood brain barrier via CO2?
Non-polar, fat soluable compounds
Does the brain vasodilate or vasoconstrict when you hyperventilate (as seen in hypocapnia)?
Vasoconstriction
About how much O2 has to be reduced before there is an effect on ventilation rate?
A significant reduction in O2, partial pressure of 60 mmHg or lower
Increasing H+ does what to ventilation rate?
Increases ventilation rate
Does H+ cross the blood brain barrier?
No
Where are the central chemoreceptors found?
CNS
Where are peripheral chemoreceptors found (specifically)?
Carotid bodies
Aortic bodies
Where do the carotid bodies’ peripheral chemoreceptors send impulses to and by what nerve?
Medulla via glossopharyngeal nerve
Where do the aortic bodies’ peripheral chemoreceptors send impulses to and by what nerve?
Medulla via vagus nerve
What is the Hering-Breuer or inflation reflex?
If lungs overfill, stretch receptors in bronchial tree send inhibitory impulses to cut inspiration off
What is the Hering-Breuer or inflation reflex normal in?
Infants
What is the difference between obstructive and restrictive lung diseases?
Obstructive: harder to get air OUT
Restrictive: harder to get air IN
Is COPD obstructive or restrictive?
Obstructive
What causes restricted lung disease?
Obesity, fibrosis, ALS
What is nitrogen narcosis?
Diving over 100ft increases pressure and forces N into plasma, becoming toxic
What is the bends?
Diver comes up too fast, causing air embolisms to clog vessels
What is pneumoconiosis?
Pathological change in lungs due to inhalation of particles
Signs of pulmonary disease/pneymoconiosis?
Clubbing of finger tips, barrel chest
What is pleurisy?
Inflamed pleura so fluid accumulates in pleural cavity
What is empyema?
Pus in pleural cavity
What is pulmonary hypertension?
Increased pulmonary blood pressure
What ventricle works harder in pulmonary hypertension and can lead to Cor Pulmonale?
Right ventricle
What is atelectasis?
Collapsed lung causes shortness of breath
What is the treatment for atelectasis?
Deep breathing exercises
What is compression atelectasis in the lungs?
Displacement of the pleural cavity by a tumor
What is a compression in the pleural cavity by blood?
Hemothorax
What is pneumothorax atelectasis?
Air in pleural cavity causes loss of negative interpleural pressure
What is absorption or obstructive atelectasis?
Alveoli blocks the air and collapses
What is patchy atelectasis caused by?
Pneumonia
What is retrolental fibroplasia?
Behind the lens scarring (premature babies placed on O2 leading to blindness)
What is a pulmonary embolism?
A foreign object getting lodged in the lungs from the blood
What % of pulmonary embolisms are from femoral/calf venous thrombi?
90%
What is cystic fibrosis?
Genetic mutation resulting in loss of Cl- channels (salty babies)
What is 2nd to heart disease as cause of disability for adults under 65?
COPD
What causes COPD?
Smoking, dust, chemical fumes, infection
What is chronic bronchitis?
Inflam of bronchi causing obstruction
What is emphysema?
Permanent enlargement of alveoli and loss of elasticity (lungs don’t collapse)
What disease has “blue boaters”?
Chronic bronchitis
What disease has “pink puffers”?
Emphysema
What causes skin to have a pinkish color which may cause Cor Pulmonale?
Polycythemia
What is an allergic inflammation with bronchospasms and mucus production?
Asthma
What is the most common form of pneumonia?
Community acquired
What % of community acquired pneumonia are gram positive streptococcus?
70%
Does gram positive streptococcus have a high or low death rate?
Low
What means hospital acquired?
Nosocomial infection
What is the most common nosocomial infection that is often drug resistant?
Gram positive staph aureus
What pneumonia has a poor prognosis with >50% mortality?
Gram negative bacteria
Is viral pneumonia bad?
No, usually relatively mild/self limiting
What causes TB?
Mycobacterium tuberculosis
Is TB airborne, waterborne, etc?
Airborne
What are the tubercles in TB filled with?
Caseous necrosis
What is the most deadly single microbe in # of deaths?
TB
What is the most common cancer cause of death?
Bronchogenic carcinomas
Do men or women get bronchogenic carcinomas?
Both
What increases risk of bronchogenic carcinomas?
Smoking, by 25x
What % of lung cancers are squamous cell?
30%
Where are the tumors in squamous cell carcinoma?
Near hilus (where things enter/leave lungs)
What % of lung cancers are small (oat) cell?
20-25%
Where are the tumors in small (oat) cell?
Central
Which carcinoma has the highest correlation with smoking?
Small (oat) cell
Which has the worst prognosis of lung cancers?
Small (oat) cell
What % of individuals live past 2 years of small (oat) cell carcinoma?
<5%
What % of lung cancers are adenocarcinomas?
30-35%
Where are tumors in adenocarcinomas and what do they do?
The periphery, often asymptomatic or behave like glands producing hormones
What % are large cell (undifferentiated) carcinomas?
10-15%
Are large cell (undifferentiated) carcinomas responsive to therapy?
No
What is a metastatic tumor?
Originates elsewhere in the body (ex. breast)
