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Didactic Year > Pathophys-pulmonary > Flashcards

Pathophys-pulmonary Flashcards

1
Q

What is the main function of the pulmonary system

A

Gas exchange

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2
Q

Ventilation

A

The physical movement of air in and out of lungs

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3
Q

Respiration

A

Gas exchange/molecules moving and exchanging

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4
Q

Non-respiratory function of the pulmonary system

A

Phonation (Vocalization)
Olfaction
Equilibrium
Metabolic role

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5
Q

Location of phonation

A

Vocal cords in larynx

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6
Q

Narrowing of trachea

A

Steeple sign

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7
Q

Steeple sign is common with what infection

A

Croup

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8
Q

Olfaction is a _______ mechanism

A

Defense

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9
Q

What helps filter and/or remove particles/bacteria

A

Nasal hair/turbinates
Muscocillary escalator
Alveolar macrophages
Surfactant

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10
Q

What is the first line of defense

A

Irritant receptors

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11
Q

First line reflexes

A

Sneeze
Cough

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12
Q

Hyperventilation allow for what

A

Acid/base compensation

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13
Q

When does hyperventilation occur

A

pH is acidic

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14
Q

Hypoventilation allows for what

A

Retain CO2 and generate more hydrogen

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15
Q

When does hypoventilation occur

A

pH is basic

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16
Q

What can a healthy pulmonary system help with

A

Compensate for metabolic acid/base disorder

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17
Q

What can a respiratory pathology cause

A

Acid/base disorder

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18
Q

What metabolic role do the lungs play

A

Release of ACE

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19
Q

What does ACE do?

A

Converts angiotensin 1 to angiotensin 2
This enzyme increases blood pressure in the RAAS and promotes inflammation/fibrosis

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20
Q

Is angiotensin 1 active or inactive

A

Inactive

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21
Q

Is angiotensin 2 active or inactive

A

Active

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22
Q

Explain angiotensin system

A

Drop in BP/Drop in fluid volume
Renin release from kidney
Angiotensinogen release from liver
Renin + angiotensinogen = angiotensin 1
ACE release from lungs
ACE + Angiotensin 1 = angiotensin 2

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23
Q

Upper air way (respiratory tract) parts

A

Nasal cavity/nasopharynx
Oropharynx
Laryngopharynx

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24
Q

Lower airways (lower respiratory tract)

A

Trachea
Bronchi
Bronchioles
Alveoli

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25
Q

Lining of upper airway

A

Ciliated mucosa
Vascular supply

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26
Q

Functions of upper airways

A

Warm/humidify air
Filter/removes particles from air as it passes through to lungs

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27
Q

Function of the larynx

A

Ventilation
Vocalization
Swallowing

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28
Q

Functional divisions of lower airways

A

Conducting zone
Respiratory zone

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29
Q

Zone with no gas exchange

A

Conducting zone

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30
Q

Location of conducting zone

A

Trachea to terminal bronchial

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31
Q

Zone of gas exchange

A

Respiratory zone

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32
Q

Location of respiratory zone

A

Respiratory bronchiole, alveolar ducts and alveoli

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33
Q

Connects larynx to bronchi

A

Trachea

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34
Q

Forms back wall of trachea

A

Trachealis muscle

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35
Q

What is the trachealis muscle analogous to

A

Smooth muscle layer in bronchi

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36
Q

Divisions of trachea

A

R/L primary bronchi

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37
Q

Junction between R/L primary bronchi

A

Carina

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38
Q

What is carina important for (diagnostic test)

A

Bronchoscopy

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39
Q

What is carina important reference point for

A

Chest imaging

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40
Q

Where is the carina located

A

Sternal angle (T4/T5)

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41
Q

What receptors are located in the carina?

A

Cough receptors (can stimulate with a catheter to test for brain death)

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42
Q

Which bronchi is larger and more prone to aspirated fluids/foreign objects

A

Right bronchi

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43
Q

Hilum

A

Roots of the lungs, blood vessels, lymph vessel, nerves

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44
Q

How many lobes on right side?
Left?

A

3= right
2= left

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45
Q

Segmental bronchi

A

10 “surgical lobes”

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46
Q

What do segmental bronchi divide into

A

Terminal bronchioles

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47
Q

Terminal bronchioles

A

Smallest airway of conducting zone (NO GAS EXCHANGE)

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48
Q

Respiratory bronchioles

A

First site of gas exchange
Alveoli present

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49
Q

What do the respiratory bronchioles branch into

A

Alveolar sacs

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50
Q

Acinus

A

Term to describe respiratory structures (respiratory bronchiole, alveolar ducts, alveoli)

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51
Q

Wall layers of conducting zone

A

Inner = mucosa
Middle = smooth muscle
Outer submucosal = connective tissue with glands
Cartilage

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52
Q

What is located in the mucosa layer?

A

Pseudostratified ciliated columnar
Goblet cells
Mucin
Clara cells
Basal cells

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53
Q

Function of goblet cells

A

Secretes mucus that contains mucin

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54
Q

Mucin

A

Glycoprotein responsible for trapping particles

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55
Q

Where is the greatest amount of goblet cells

A

Larger airways —> gradually diminish to minimal at terminal bronchioles

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56
Q

What are Clara cells

A

Goblet like cells in terminal bronchioles

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57
Q

Difference between ciliated and goblet cells

A

Ciliated = mucus transport
Goblet = mucus production

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58
Q

Where is the most abundance of smooth muscle

A

Larger airways —> thins as it reaches terminal bronchiole

59
Q

What will inflammation/immune response stimulate

A

Constriction & potential hypertrophy

60
Q

What constricts smooth muscle

A

Acetylcholine stimulates of cholinergic receptors

61
Q

Epinephrine works as what

A

Bronchodilator

62
Q

How does epinephrine induce bronchodilation

A

Stimulates beta 2 receptors —> relax bronchial
Smooth muscle —> inhibit parasympathetic influence (anticholinergic)

63
Q

What does the submucosa layer include

A

Loose connective tissue containing mucus secreting glands (sub-mucosal glands)

64
Q

What does the sub-mucosal glands produce?

A

Mucin
Serous fluids

65
Q

What determines the solubility of bronchial secretions

A

Amount of mucin + water + electrolytes

66
Q

What does mucinex do?

A

Increase volume and reduce the viscosity of secretions of the submucosa

67
Q

What’s the outermost layer of the conducting zone?

A

Cartilage

68
Q

Where does air flow occur?

A

Trachea/primary bronchi

69
Q

Air flow in the trachea has a _________ velocity

A

Fast

70
Q

What is the area of the trachea/primary bronchi

A

Small cross section area

71
Q

What is the area of the lobar bronchi/terminal bronchi

A

Large cross section

72
Q

Air flow in the lobar/terminal bronchi has a ______________velocity

A

Slow

73
Q

What does the conducting zone represent

A

Anatomical dead space

74
Q

What is dead space

A

Inspired air that does not reach gas exchange (so it’s expelled: 150 ml)

75
Q

Alveolar ventilation

A

Air that reaches gas exchange

76
Q

What does the acinus include

A

Bronchiole, alveolar ducts, alveolar sacs

77
Q

Where is the first site of gas exchange

A

Respiratory bronchioles

78
Q

Where does the respiratory bronchioles terminate

A

Alveolar sac

79
Q

What is an alveolar sac

A

Grape like clusters of individual alveoli

80
Q

What allows adjacent alveoli to exchange air between each other

A

Pores of Kohn

81
Q

Site of primary gas exchange

A

Alveoli

82
Q

Alveolar septa

A

Two layers of the alveoli

83
Q

Layers of the alveolar septa

A

Epithelial
Basement

84
Q

Type 1 alveolar cells

A

Physical make up that creates cells that provide physical structure to alveoli

85
Q

Type 2 alveolar cells

A

Produces surfactant

86
Q

Function of basement membrane

A

Fuses with membrane adjacent to allow gas exchange

87
Q

What are the types of irritant receptors

A

Sneeze reflex (nasal cavity)
Cough reflex (trachea/large conducting)

88
Q

Function of cough reflex receptors

A

Proximal conducting zone

89
Q

How do you diagnose brain death

A

Cannula stimulates carina to produce cough with tracheobronchial suctioning

90
Q

Particles trapped in mucous layer are propelled by what and where

A

By cilia of columnar epithelium
Towards trachea

91
Q

What are “type 3” alveolar cells

A

Alveolar macrophages

92
Q

Function of alveolar macrophages

A

Ingest and remove foreign particles/bacteria —-> move towards terminal bronchiole

93
Q

What occurs if alveolar macrophages can’t migrate up

A

Scarring and inflammation (ie. emphysema)

94
Q

How are particles removed from lungs

A

Lymphatics

95
Q

If particles/microorganisms are not removed from large airways what will occur

A

Immune response
Cellular and inflammatory responses will attack

96
Q

What filters and traps particles >10 um

A

Nasal hair

97
Q

Particles < 2um in diameter may reach

A

Alveoli (respiratory zone)
Either engulfed by alveolar macrophages or injure the epithelium and lead to further disease

98
Q

Pulmonary circulation

A

“Un-oxygenated” blood flow from pulmonary trunk of right ventricle to pulmonary capillaries for gas exchange

99
Q

Bronchial circulation

A

“Oxygenated” blood flow from left ventricle supplies structures of pulmonary system

100
Q

Function of pulmonary circulation

A

Facilitates gas exchange
Acts as a reservoir for left ventricle
Acts as a filter system to remove particles/emboli (clots or air)

101
Q

Pulmonary circulation has a _____ pressure even though same stroke volume as left side of heart

A

Low
10-20 mmHg

102
Q

What is the fraction of pulmonary blood vessels perfused at any given time

A

1/3
accommodates increased stroke volume w/out increasing pressures

103
Q

Why is the density of capillaries so high

A

Allows a lot of blood to be exposed to the gas in the alveoli

104
Q

What merges together to form gas exchange membrane

A

Alveolar and capillary walls

105
Q

Components of alveolocapillary membrane

A

Alveolar epithelium
“merged” basement membranes
capillary epithelium

106
Q

Damage to alveolocapillary membrane causes what

A

Plasma/blood can leak into alveolar space
Impair gas exchange

107
Q

Hypoxic vasoconstriction

A

Damage or partial pressure of O2 drops, arterioles will constrict and send blood away from the damaged site

108
Q

Pulmonary veins

A

Drains capillary beds and return blood back to left ventricle

109
Q

T/F bronchial circulation does not participate in gas exchange

A

True

110
Q

What do the bronchial arteries supply

A

Structures of the lungs

111
Q

Function of bronchial circulation

A

Supply nutrients to the structure of the lungs

112
Q

Bronchial capillaries drain into pulmonary veins returning to left atria create what

A

Right to left shunt

113
Q

Un oxygenated blood passing into oxygenated circulation

A

Right to left shunt

114
Q

Atrial defect allowing unoxygenated blood from right atria to leak into oxygenated of left atria is an example of what

A

Right to left shunt

115
Q

Where are lymphatic vessels not located in the lungs

A

Respiratory bronchioles
Alveoli ducts
Alveoli
(not in gas exchange area)

116
Q

Path of accumulating fluid in alveoli

A

Alveolar macrophages —> terminal bronchioles —> drain into lymphatic system at terminal bronchioles

117
Q

Lungs serve as a mechanism to increase/decrease

A

pH of the bloodstream
Lungs are able to do this by
increasing/decreasing rate of CO 2 removal from body

118
Q

Respiration requires __________

A

Ventilation

119
Q

ACE 2

A

This enzyme lowers blood pressure and has an anti-inflammatory and antioxidant effect

120
Q

________ counteracts the negative consequences of _______

A

ACE 2, ACE

121
Q

ACE 2 converts

A

Angio 2 to angio (1-7)

122
Q

In a healthy individual, they will have an optimal __________ ratio

A

ACE 2/ACE

123
Q

What factors can contribute to a poor ACE/ACE 2 ratio?

A

Diabetes, smoking, advanced age, HTN, obesity

124
Q

COVID 19 binds to what

A

Ace 2

125
Q

Why would Covid attacking Ace 2 be bad?

A

With limited ace 2 activity, the fibrotic/inflammatory effects of ace would be dominant and lead to advanced disease

126
Q

Larynx divides the ______ and ________ airways

A

Upper, lower

127
Q

Pores of Kohn

A

Small openings in the alveolar walls that allow gases and macrophages to travel between the alveoli

128
Q

What is not found in the terminal bronchioles?

A

Cartilage

129
Q

Mucosa is composed of what type of tissue

A

Pseudo stratified cilliated columnar epithelium

130
Q

Clara (club) cells produce

A

Serous fluid

131
Q

What “connects” smooth muscle layer to epithelium?

A

Lamina propria

132
Q

Sympathetic stimulation of B-2 receptors will ___________ bronchial smooth muscle

A

Relax/dilate (Think: need more air to run away from a bear)

133
Q

What is the “last defense” if micro particles/bacteria get to the alveoli?

A

Alveolar macrophages

134
Q

Particles 2-10 um will be

A

Trapped in the Muscocillary escalator
expelled

135
Q

Leakage of plasma/blood into the alveolar space is called

A

Pulmonary edema

136
Q

The lymphatic capillaries drain what

A

Accumulating fluid and alveolar macrophages

137
Q

Visceral pleura

A

Covers the lungs

138
Q

Parietal pleura

A

Lines the thoracic cavity

139
Q

The ___________ pleura produces well-localized pain

A

Parietal

140
Q

The _____________ pleura is not very sensitive to pain, temp, touch etc.

A

Visceral

141
Q

What is normal pressure on the pleural space?

A

-4 to -10 mmHg

142
Q

Normal TV

A

500 ml

143
Q

Normal RR

A

12-20

Didactic Year (24 decks)

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