Pathophys-pulmonary Flashcards
1
Q
What is the main function of the pulmonary system
A
Gas exchange
2
Q
Ventilation
A
The physical movement of air in and out of lungs
3
Q
Respiration
A
Gas exchange/molecules moving and exchanging
4
Q
Non-respiratory function of the pulmonary system
A
Phonation (Vocalization)
Olfaction
Equilibrium
Metabolic role
5
Q
Location of phonation
A
Vocal cords in larynx
6
Q
Narrowing of trachea
A
Steeple sign
7
Q
Steeple sign is common with what infection
A
Croup
8
Q
Olfaction is a _______ mechanism
A
Defense
9
Q
What helps filter and/or remove particles/bacteria
A
Nasal hair/turbinates
Muscocillary escalator
Alveolar macrophages
Surfactant
10
Q
What is the first line of defense
A
Irritant receptors
11
Q
First line reflexes
A
Sneeze
Cough
12
Q
Hyperventilation allow for what
A
Acid/base compensation
13
Q
When does hyperventilation occur
A
pH is acidic
14
Q
Hypoventilation allows for what
A
Retain CO2 and generate more hydrogen
15
Q
When does hypoventilation occur
A
pH is basic
16
Q
What can a healthy pulmonary system help with
A
Compensate for metabolic acid/base disorder
17
Q
What can a respiratory pathology cause
A
Acid/base disorder
18
Q
What metabolic role do the lungs play
A
Release of ACE
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
20
Q
Is angiotensin 1 active or inactive
A
Inactive
21
Q
Is angiotensin 2 active or inactive
A
Active
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
23
Q
Upper air way (respiratory tract) parts
A
Nasal cavity/nasopharynx
Oropharynx
Laryngopharynx
24
Q
Lower airways (lower respiratory tract)
A
Trachea
Bronchi
Bronchioles
Alveoli
25
Lining of upper airway
Ciliated mucosa
Vascular supply
26
Functions of upper airways
Warm/humidify air
Filter/removes particles from air as it passes through to lungs
27
Function of the larynx
Ventilation
Vocalization
Swallowing
28
Functional divisions of lower airways
Conducting zone
Respiratory zone
29
Zone with no gas exchange
Conducting zone
30
Location of conducting zone
Trachea to terminal bronchial
31
Zone of gas exchange
Respiratory zone
32
Location of respiratory zone
Respiratory bronchiole, alveolar ducts and alveoli
33
Connects larynx to bronchi
Trachea
34
Forms back wall of trachea
Trachealis muscle
35
What is the trachealis muscle analogous to
Smooth muscle layer in bronchi
36
Divisions of trachea
R/L primary bronchi
37
Junction between R/L primary bronchi
Carina
38
What is carina important for (diagnostic test)
Bronchoscopy
39
What is carina important reference point for
Chest imaging
40
Where is the carina located
Sternal angle (T4/T5)
41
What receptors are located in the carina?
Cough receptors (can stimulate with a catheter to test for brain death)
42
Which bronchi is larger and more prone to aspirated fluids/foreign objects
Right bronchi
43
Hilum
Roots of the lungs, blood vessels, lymph vessel, nerves
44
How many lobes on right side?
Left?
3= right
2= left
45
Segmental bronchi
10 “surgical lobes”
46
What do segmental bronchi divide into
Terminal bronchioles
47
Terminal bronchioles
Smallest airway of conducting zone (NO GAS EXCHANGE)
48
Respiratory bronchioles
First site of gas exchange
Alveoli present
49
What do the respiratory bronchioles branch into
Alveolar sacs
50
Acinus
Term to describe respiratory structures (respiratory bronchiole, alveolar ducts, alveoli)
51
Wall layers of conducting zone
Inner = mucosa
Middle = smooth muscle
Outer submucosal = connective tissue with glands
Cartilage
52
What is located in the mucosa layer?
Pseudostratified ciliated columnar
Goblet cells
Mucin
Clara cells
Basal cells
53
Function of goblet cells
Secretes mucus that contains mucin
54
Mucin
Glycoprotein responsible for trapping particles
55
Where is the greatest amount of goblet cells
Larger airways —> gradually diminish to minimal at terminal bronchioles
56
What are Clara cells
Goblet like cells in terminal bronchioles
57
Difference between ciliated and goblet cells
Ciliated = mucus transport
Goblet = mucus production
58
Where is the most abundance of smooth muscle
Larger airways —> thins as it reaches terminal bronchiole
59
What will inflammation/immune response stimulate
Constriction & potential hypertrophy
60
What constricts smooth muscle
Acetylcholine stimulates of cholinergic receptors
61
Epinephrine works as what
Bronchodilator
62
How does epinephrine induce bronchodilation
Stimulates beta 2 receptors —> relax bronchial
Smooth muscle —> inhibit parasympathetic influence (anticholinergic)
63
What does the submucosa layer include
Loose connective tissue containing mucus secreting glands (sub-mucosal glands)
64
What does the sub-mucosal glands produce?
Mucin
Serous fluids
65
What determines the solubility of bronchial secretions
Amount of mucin + water + electrolytes
66
What does mucinex do?
Increase volume and reduce the viscosity of secretions of the submucosa
67
What’s the outermost layer of the conducting zone?
Cartilage
68
Where does air flow occur?
Trachea/primary bronchi
69
Air flow in the trachea has a _________ velocity
Fast
70
What is the area of the trachea/primary bronchi
Small cross section area
71
What is the area of the lobar bronchi/terminal bronchi
Large cross section
72
Air flow in the lobar/terminal bronchi has a ______________velocity
Slow
73
What does the conducting zone represent
Anatomical dead space
74
What is dead space
Inspired air that does not reach gas exchange (so it’s expelled: 150 ml)
75
Alveolar ventilation
Air that reaches gas exchange
76
What does the acinus include
Bronchiole, alveolar ducts, alveolar sacs
77
Where is the first site of gas exchange
Respiratory bronchioles
78
Where does the respiratory bronchioles terminate
Alveolar sac
79
What is an alveolar sac
Grape like clusters of individual alveoli
80
What allows adjacent alveoli to exchange air between each other
Pores of Kohn
81
Site of primary gas exchange
Alveoli
82
Alveolar septa
Two layers of the alveoli
83
Layers of the alveolar septa
Epithelial
Basement
84
Type 1 alveolar cells
Physical make up that creates cells that provide physical structure to alveoli
85
Type 2 alveolar cells
Produces surfactant
86
Function of basement membrane
Fuses with membrane adjacent to allow gas exchange
87
What are the types of irritant receptors
Sneeze reflex (nasal cavity)
Cough reflex (trachea/large conducting)
88
Function of cough reflex receptors
Proximal conducting zone
89
How do you diagnose brain death
Cannula stimulates carina to produce cough with tracheobronchial suctioning
90
Particles trapped in mucous layer are propelled by what and where
By cilia of columnar epithelium
Towards trachea
91
What are “type 3” alveolar cells
Alveolar macrophages
92
Function of alveolar macrophages
Ingest and remove foreign particles/bacteria —-> move towards terminal bronchiole
93
What occurs if alveolar macrophages can’t migrate up
Scarring and inflammation (ie. emphysema)
94
How are particles removed from lungs
Lymphatics
95
If particles/microorganisms are not removed from large airways what will occur
Immune response
Cellular and inflammatory responses will attack
96
What filters and traps particles >10 um
Nasal hair
97
Particles < 2um in diameter may reach
Alveoli (respiratory zone)
Either engulfed by alveolar macrophages or injure the epithelium and lead to further disease
98
Pulmonary circulation
“Un-oxygenated” blood flow from pulmonary trunk of right ventricle to pulmonary capillaries for gas exchange
99
Bronchial circulation
“Oxygenated” blood flow from left ventricle supplies structures of pulmonary system
100
Function of pulmonary circulation
Facilitates gas exchange
Acts as a reservoir for left ventricle
Acts as a filter system to remove particles/emboli (clots or air)
101
Pulmonary circulation has a _____ pressure even though same stroke volume as left side of heart
Low
10-20 mmHg
102
What is the fraction of pulmonary blood vessels perfused at any given time
1/3
accommodates increased stroke volume w/out increasing pressures
103
Why is the density of capillaries so high
Allows a lot of blood to be exposed to the gas in the alveoli
104
What merges together to form gas exchange membrane
Alveolar and capillary walls
105
Components of alveolocapillary membrane
Alveolar epithelium
“merged” basement membranes
capillary epithelium
106
Damage to alveolocapillary membrane causes what
Plasma/blood can leak into alveolar space
Impair gas exchange
107
Hypoxic vasoconstriction
Damage or partial pressure of O2 drops, arterioles will constrict and send blood away from the damaged site
108
Pulmonary veins
Drains capillary beds and return blood back to left ventricle
109
T/F bronchial circulation does not participate in gas exchange
True
110
What do the bronchial arteries supply
Structures of the lungs
111
Function of bronchial circulation
Supply nutrients to the structure of the lungs
112
Bronchial capillaries drain into pulmonary veins returning to left atria create what
Right to left shunt
113
Un oxygenated blood passing into oxygenated circulation
Right to left shunt
114
Atrial defect allowing unoxygenated blood from right atria to leak into oxygenated of left atria is an example of what
Right to left shunt
115
Where are lymphatic vessels not located in the lungs
Respiratory bronchioles
Alveoli ducts
Alveoli
(not in gas exchange area)
116
Path of accumulating fluid in alveoli
Alveolar macrophages —> terminal bronchioles —> drain into lymphatic system at terminal bronchioles
117
Lungs serve as a mechanism to increase/decrease
pH of the bloodstream
Lungs are able to do this by
increasing/decreasing rate of CO 2 removal from body
118
Respiration requires __________
Ventilation
119
ACE 2
This enzyme lowers blood pressure and has an anti-inflammatory and antioxidant effect
120
________ counteracts the negative consequences of _______
ACE 2, ACE
121
ACE 2 converts
Angio 2 to angio (1-7)
122
In a healthy individual, they will have an optimal __________ ratio
ACE 2/ACE
123
What factors can contribute to a poor ACE/ACE 2 ratio?
Diabetes, smoking, advanced age, HTN, obesity
124
COVID 19 binds to what
Ace 2
125
Why would Covid attacking Ace 2 be bad?
With limited ace 2 activity, the fibrotic/inflammatory effects of ace would be dominant and lead to advanced disease
126
Larynx divides the ______ and ________ airways
Upper, lower
127
Pores of Kohn
Small openings in the alveolar walls that allow gases and macrophages to travel between the alveoli
128
What is not found in the terminal bronchioles?
Cartilage
129
Mucosa is composed of what type of tissue
Pseudo stratified cilliated columnar epithelium
130
Clara (club) cells produce
Serous fluid
131
What "connects" smooth muscle layer to epithelium?
Lamina propria
132
Sympathetic stimulation of B-2 receptors will ___________ bronchial smooth muscle
Relax/dilate (Think: need more air to run away from a bear)
133
What is the "last defense" if micro particles/bacteria get to the alveoli?
Alveolar macrophages
134
Particles 2-10 um will be
Trapped in the Muscocillary escalator
expelled
135
Leakage of plasma/blood into the alveolar space is called
Pulmonary edema
136
The lymphatic capillaries drain what
Accumulating fluid and alveolar macrophages
137
Visceral pleura
Covers the lungs
138
Parietal pleura
Lines the thoracic cavity
139
The ___________ pleura produces well-localized pain
Parietal
140
The _____________ pleura is not very sensitive to pain, temp, touch etc.
Visceral
141
What is normal pressure on the pleural space?
-4 to -10 mmHg
142
Normal TV
500 ml
143
Normal RR
12-20
