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Thompson Exam 4 and 5 > Exam 5 4.20 Pulmonary.Part 1 > Flashcards

Exam 5 4.20 Pulmonary.Part 1 Flashcards

1
Q

2 structures in the upper airways (conducting airways)

A
  • Nasopharynx
  • Oropharynx
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2
Q

2 things to know about the Larynx

A
  • Connects upper and lower airways
  • site of vocal cords
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3
Q

3 structures of the Lower airways- and general description of each

A
  1. Trachea – branches into 2 main airways at the carina, R and L bronchi
  2. Bronchi – enter lung at the hilum of each lung
  3. Terminal bronchioles – tree-like division of bronchi into bronchioles, until the smallest ones connect to the alveoli
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4
Q

3 structures of the Gas-exchange airways

A
  • Respiratory bronchioles
  • Alveolar ducts
  • Alveoli
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5
Q

Two types of Epithelial cells in Alveoli

A
  • †Type I alveolar cells - Alveolar structure
  • †Type II alveolar cells - Surfactant production
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6
Q

True or False: ˜Pulmonary circulation has a higher pressure than the systemic circulation

A

False

It has a lower pressure

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7
Q

One-third of pulmonary vessels are filled with what?

A

Filled with blood at any given time

  • This allows space for extra blood during ↑ cardiac activity, keeping pulmonary pressure stable
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8
Q

Where does Pulmonary artery enter the lungs?

A

Pulmonary artery divides and enters the lung at the hilum

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9
Q

What does each bronchus and bronchiole have?

A

˜an accompanying artery or arteriole

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10
Q

˜3 things to know about alveolocapillary membrane

A
  • Formed by the shared alveolar and capillary walls
  • Gas exchange occurs across this membrane
  • Any disorder that thickens this membrane impairs gas exchange
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11
Q

3 basic points about ˜Pulmonary veins and circulation

A
  • Each drains several pulmonary capillaries
  • Dispersed randomly throughout the lung
  • Leave the lung at the hila and enter the left atrium
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12
Q

What makes up the chest wall?

A
  • Skin, ribs, and intercostal muscles
    • Function is protection and muscular support for breathing
  • Thoracic cavity
    • Encases the lungs
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13
Q

What makes up the pleura?

A
  • Is a serous membrane
  • Parietal and visceral layers
  • Pleural space (cavity)
  • Pleural fluid
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14
Q

How much Pleural fluid do we have and why do we have it?

A

about 1 ½ teaspoons around each lung, just enough to provide surface tension between parietal and visceral layers

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15
Q

Define ˜Ventilation

A

Mechanical movement of gas or air into and out of the lungs

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16
Q

What is Minute volume and some norms?

A
  • Ventilatory rate multiplied by the volume of air per breath (tidal volume)
  • Average breaths per minute is ~ 14-18
  • Average tidal volume is 8-10 ml/kg of weight (book uses 500 ml as an average)

Example: For a 70 kg (154 lb.) person, 15 breaths/minute
70 X 10 X 15 = 10,500 ml = 10.5 L

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17
Q

Major muscles of inspiration

A
  • Diaphragm
  • External intercostals – “hands in front pockets”
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18
Q

Accessory muscles of inspiration

A
  • Sternocleidomastoid muscle
  • Scalene muscles
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19
Q

Accessory muscles of expiration

A
  • Abdominal intercostal muscles
  • Internal intercostal muscles – “hands in back pockets”
  • There are no major muscles of expiration –it’s a passive event
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20
Q

What is the Function of surfactant in ˜Alveolar surface tension and ventilation?

How does it work?

When things go wrong….

A
  • reduces surface tension
  • liquid molecules exposed to air tend to adhere to each other
  • Lack of surfactant is a major reason that premature babies require ventilator support
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21
Q

Why are there elastic properties of the lung and chest wall?

A
  • ˜maintains normal negative pressure of pleural space
  • Elastic recoil – lungs will return to resting state after inspiration, thereby permitting passive expiration
  • Compliance – relative ease of lung “stretching”
  • Volume change per unit of pressure change
    • Determined by alveolar surface tension and elastic recoil
22
Q

Changes with elasticity in lung that occur with aging and pathology

A
  • ↑ with normal aging and disorders such as emphysema; stretch too easily
  • ↓ in ARDS (acute respiratory distress syndrome, pneumonia, fibrosis, pulmonary edema); stiffer
23
Q

What determines ˜Airway resistance?

A

Determined by size of airway and density, viscosity, velocity of the gas

24
Q

Some causes of increased airway resistance

A
  • Bronchoconstriction
  • mucus
  • inflammation
25
Q

Muscular effort ↑ in the work of breathing with these 3 issues

A
  1. Lung compliance ↓ (fibrosis, pulmonary edema)
  2. Chest wall compliance ↓ (obesity, spinal deformity)
  3. Airways are obstructed by spasm or mucous (asthma, acute bronchitis)
26
Q

What is measured when taking Measurement of Gas Pressure?

A
  • Pressure and volume measurements made in pulmonary function testing labs specify the temperature and humidity of gases at the time of measurement
  • Air is 78% N, 21% O2, rest is water vapor, CO2, minute concentrations of noble gases

​

27
Q

Points about ventilation and perfusion (6)

A
  • ˜Distribution of ventilation and perfusion – need to have an approximately even distribution of gas (ventilation) and blood (perfusion) in all parts of the lung
  • Gravity and alveolar pressure – the most dependent part of the lung will have the best perfusion (fig. 25-14, p. 671)
  • If gas pressure in alveoli exceeds the blood pressure in the capillary, the capillary collapses and flow ceases
  • Ventilation-perfusion ratio (V/Q ratio)- Perfusion exceeds ventilation in the bases, and ventilation exceeds perfusion in the apices
  • Normal V/Q is 0.8, with perfusion exceeding ventilation
  • Body position changes the areas of perfusion and ventilation
28
Q

Location of O2 transport and determinants of arterial oxygenation

A
  • Diffusion across the alveolocapillary membrane – takes ~0.75 second
  • Determinants of arterial oxygenation:
    • Hemoglobin binding – O2 moves to the RBCs and binds with hemoglobin
    • Oxygen saturation (Sao2) is % of available hemoglobin bound to O2; measured with oximeter
    • Important measure of pulmonary function
29
Q

Pic of the various volumes and whatnot in lung capacity

A
30
Q

What is spirometry?

A

˜how much air inhaled, and exhaled, and how quickly

31
Q

What is Diffusion capacity?

A

˜how much O2 travels from alveoli to the blood stream, measuring carbon monoxide

32
Q

What is Residual volume?

A

˜amount of air left in lungs after forced expiration – is estimated, can’t be directly measured

33
Q

What is ˜Functional reserve capacity (FRC)?

A

amount of air left in lung after a normal expiration

34
Q

What is Total lung capacity?

A

inspiratory capacity + functional residual capacity; volume of air in the lungs at the end of a maximal inspiration

35
Q

What is measured in ˜Arterial blood gas analysis? (4)

A
  • O2
  • CO2
  • arterial O2 saturation
  • pH
36
Q

Tests and measures used to evaluate pulmonary function (8)

A
  • ˜Spirometry
  • Pulmonary Function Testing (PFT)
  • ˜Diffusion capacity
  • Residual volume
  • Functional reserve capacity (FRC)
  • Total lung capacity
  • ˜Arterial blood gas analysis
  • Chest radiographs
37
Q

Basic meaning of Obstructive and Restrictive

A

Obstructive - trouble getting air out of lungs

Restrictive – trouble getting air in

38
Q

Restrictive lung diseases (10)

A
  • Pulmonary Fibrosis
  • Inhalation disorders- obesity
  • Pneumoconiosis- coal miners
  • Allergic alveolitis
  • Lung Cancer
  • Scleroderma
  • Cystic Fibrosis
  • Scoliosis
  • Ankylosing Spondylitis
  • Neuromuscular Disorders
39
Q

˜Obstructive lung diseases (3)

A
  • Emphysema
  • Chronic Bronchitis
  • Asthma
40
Q

General info about restrictive diseases (4)

A
  • Lungs stiffer, less compliant
  • Requires ↑ transpulmonary pressure to expand the lung
  • All lung volumes and capacities ↓; degree will depend on source of restriction
  • Patients experience respiratory muscle fatigue, overuse, and failure
41
Q

Signs of Restrictive Lung Disease (7)

A
  • ˜Tachypnea
  • ˜Hypoxemia
  • ˜↓breath sounds
  • ˜↓lung volumes and capacities
  • ˜Cor pulmonale (R sided heart failure)
  • ˜Altered chest radiograph (varies according to disease)
  • ˜Pulmonary hypertension
42
Q

Symptoms of Restrictive Lung Disease (4)

A
  • Dyspnea
  • Cough
  • Weight loss
  • Muscle wasting
43
Q

Changes in lung volume measures in restrictive diseases

A

˜Decreased:

  • TLC
  • FEV1
  • FVC
  • FRC
  • IC

˜FEV1/FVC ratio remains normal

44
Q

Supportive Measures for Restrictive Lung Disease (4)

A
  • Supplemental O2 if Pao2 ≤ 55 mm Hg or ≤ 59 mm Hg with signs of right-sided heart strain or polycythemia
  • Antibiotic therapy for secondary infections
  • Interventions to promote adequate ventilation (CPAP, BiPAP, ventilator)
  • Good nutritional support
45
Q

General Info about Obstructive Lung Diseases (6)

A
  • Expiratory airflow is obstructed
  • ↑ residual volume (physiologic dead space)
  • Retained secretions
  • Inflammation of mucosal lining of airway walls
  • Bronchial constrictions related to ↑tone or spasm of bronchial smooth muscle
  • Weakening of the support structure of airway walls
46
Q

Signs/Symptoms of Obstructive Lung Diseases

A
  • ˜Elevation of shoulder girdle
  • ˜Horizontal ribs
  • ˜Barrel-shaped thorax (↑ A-P diameter)
  • ˜Low, flattened diaphragm
  • ˜Spirometry is better measure of OLD than CXR
  • ˜Orthopnea- dyspnea lying flat
  • ˜Paroxysmal nocturnal dyspnea- night time coughing or SOB that awakens patient
47
Q

Emphysema vs. Chronic bronchitis

A

Emphysema form – destruction of alveolar walls, enlargement of air spaces distal to terminal bronchioles

  • Smoking is a major determinant

Chronic bronchitis – presence of chronic productive cough for 3 months in each of 2 successive years (other diseases ruled out) – hypersecretion and hypertrophy of submucosal glands

Most COPD patients have mixed pathology

48
Q

Pink Puffers vs. Blue Bloaters

A
49
Q

Pic with info about Emphysema – “Pink Puffer”

A
50
Q

Pic with info about Chronic Bronchitis – “Blue Bloater”

A

Thompson Exam 4 and 5 (9 decks)

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