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Pace- Patho > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

Conducting airways

A

– Provide for movement of air from the external environment to the point of gas exchange.
Contains just over 20 subdivisions
– Lined with pseudostratified columnar
epithelium

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2
Q

Bronchioles are

A

smallest conducting airway.
* No smooth muscle or cartilage
* Retention of ciliated cuboidal epithelium

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3
Q

Terminal respiratory units are

A

– Respiratory bronchioles and alveolar ducts

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4
Q

autonomic nervous system

A

parasympathetic
sympathetic

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5
Q

Afferents are primarily vagal.

A
  • Bronchopulmonary stretch receptors
  • Irritant receptors in proximal airway
  • C-fibers– Respond to mechanical and chemical stimuli
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6
Q

Efferents

A
  • Muscarinic bronchoconstriction-
  • Pulmonary vasodilation
  • Mucus gland secretion
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7
Q

Sympathetic fibers at rest

A

– Bronchial smooth muscle relaxation
– Pulmonary vasoconstriction
– Inhibition of secretory gland activity

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8
Q

NANC fibers

A

Functions primarily as reciprocal balance to excitatory cholinergic system

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9
Q

Two main components of flow:

A

pulmonary and bronchial

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10
Q

bronchial vessels

A

supply arterial blood to the bronchi to feed it and takes away deoxiginated blood

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11
Q

pulmonary lymphatics

A
  • Run along airway and vascular system

– Found in connective tissue spaces of pleura and peribronchovascular sheaths, interlobular septa

– Terminate in bronchioles (do not enter alveoli)

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12
Q

compliance

A

ability of tissue to comply
- Intrinsic elastic property that relates a change in volume to a change in pressure

– Both compliance of chest wall and lungs contribute to pulmonary compliance.

– Chest wall does not change significantly with volume.

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13
Q

elastic recoil

A

ability to return back to its original shape

Determined by the shape/structure of the thorax

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14
Q

Two contributing factors to elastic recoil

A
  • Tissue elasticity
  • Force needed to change shape of air-liquid interface of alveoli
    – Surface tension is directly proportionate to surface forces that the lung has to overcome to expand.
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15
Q

Inflation overcomes three opposing forces.

A
  • Elastic recoil
    – Inertia of the respiratory system
    (insignificant)
    – Resistance to airflow
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16
Q

Laminar flow–

A

Airway caliber is the principal determinant of airway resistance.

moving in 1 direction, no resistant

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17
Q

Turbulent flow

A

– Driving pressure is proportionate to the flow rate.
driving pressure to keep flow

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18
Q

Turbulent flow

A

– Driving pressure is proportionate to the flow rate.
driving pressure to keep flow

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19
Q

flow is turbulent at the

A

top
trachea

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20
Q

flow is laminar at

A

bottom
alveoli
bronchioles

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21
Q

most negative pressure is at the

A

apex of the heart

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22
Q

Distribution of perfusion

A

– Gravity influences distribution.
– In an upright patient there is a linear increase in flow from apex to base.

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23
Q

Hypoxic pulmonary vasoconstriction– Pulmonary arterioles are sensitive to alveolar.

A

pO2

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24
Q

When alveolar pO2 falls, resistance to flow

A

increases.

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24
Q

When alveolar pO2 falls, resistance to flow

A

increases.

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25
Q

Minute ventilation is

A

6 L/min.

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26
Q

Minute ventilation is

A

6 L/min.

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27
Q

Pulmonary artery blood flow is

A

5 L/min.

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28
Q

Overall V/Q ratio is.

A

0.8

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29
Q

is anatomical dead space.

A

2 L

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30
Q

Resting alveolar ventilation is

A

4 L/min.

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31
Q

If the area is too large, the A-a (atmospheric and arterial)gradient

A

increases.

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32
Q

Shunt–

A

Perfusion without ventilation

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33
Q

Atelectasis or consolidation

A
  • Both pO2 and pCO2 fall because remaining respiratory units are over-ventilated relative to blood flow.
  • Shunt cannot correct low pO2 by increasing minute ventilation.
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34
Q

sensory input

A

frequency, depth, timing of spontaneous breathing are modified by chemical and mechanical receptors.

35
Q

carotid bodies

A

Chemoreceptors at bifurcation of common
carotid and aortic branch
– As pO2 falls, carotid body fires signals to medullary center.

36
Q

Central chemoreceptors

A

– Mediate response to increased pCO2
– Dispersed throughout the brainstem
– Increased ventilation rate in response to increased pCO2 is a function of chemoreceptors.

37
Q

Pulmonary stretch receptors

A

– Located in the airway smooth muscle and
mucosa
– Discharge in response to distention of the lung
– Increased lung volume decreases respiratory rate as a result of increased expiration time (Hering-Breuer reflex).

38
Q

C-fibers near pulmonary capillary receptors are stimulated by irritants.Increases respiratory drive in

A

interstitial edema and pulmonary fibrosis

39
Q

Proprioceptors

A

– Skeletal movement transmits to respiratory centers.
* Increased ventilation during exercise

40
Q

Spindle receptors

A
  • In diaphragm and intercostals provide feedback on muscle work
  • When work is disproportionate to ventilation, dyspnea occurs
41
Q

Chronic hypercapnia

A

– Brain pH is compensated.
– Central chemoreceptors less sensitive to arterial paCO2
– Carotid body drive is imperative.

42
Q

Chronic hypoxia
.

A

– High altitudes, sleep apnea
– Lung disease and hypercapnia can remove endogenous stimuli to breathe

43
Q

Which of the following is not true with respect to conducting airways?

A

Secretory glands increase as airway divides.

44
Q

The section of the airway that offers the least resistance to airflow is the:

A

Terminal respiratory unit.

44
Q

The section of the airway that offers the least resistance to airflow is the:

A

Terminal respiratory unit.

45
Q

Autonomic innervation is the primary determinant of smooth muscle activity in the airway. Irritant receptors in the proximal airway are an example of:

A

Vagal afferents.

46
Q

The NANC fibers serve primarily to:

A

Provide reciprocity to cholinergic excitation

47
Q

The __________________ are very sensitive to alveolar partial pressure of oxygen (pO2).

A

Pulmonary arteries.

48
Q

Elastic recoil is determined by:

A

Tissue elasticity and force needed to change alveolar air-liquid interface.

49
Q

pulomanry obstructive disease

A

asthma and COPD

50
Q

Asthma

A

an accelerated, inappropriate chronic inflammatory response occurring in response to any variety of triggers

51
Q

Local inflammatory cells are activated:

A

Primarily mast cells and eosinophils.

52
Q

Acute-acting mediators are released.

A

*cause bronchoconstriction

Leukotrienes
* Prostaglandins
* Histamine

53
Q

Acute-acting mediators stimulate a variety of responses.

A

– Smooth muscle contraction
– Mucus hypersecretion
– Vasodilation
– Endothelial leakage
– Local edema formation

54
Q

COPD

A

A disease characterized by persistent and progressive airflow limitation that is not fully reversible

normal response

55
Q

Chronic bronchitis may or may not be present in

A

COPD

56
Q

Chronic bronchitis

A

mucous hyper secretion
-wet cough constantly

A result of chronic airway injury and narrowing
– Inflammation of the small airways
– Hypertrophy of large airway mucus glands
– Increased mucus production

57
Q

Chronic bronchitis, Normal ciliated pseudostratified squamous epithelium is replaced by

A

squamous metaplasia

58
Q

COPD has to do with

A

airflow limitation

59
Q

Emphysema

A

A disease of lung parenchyma – not airways
- alveola lose their attachment to lunch parenchyma
Loss of alveolar surface area and accompanying bed decrease gas exchange producing hypoxia and dyspnea.

60
Q

Types of Emphysema

A

Centriacinar emphysema
Panacinar emphysema

61
Q

Centriacinar emphysema

A

This is the type most often associated with smoking.

62
Q

FEV1

A

how much a patient can put out in 1 sec

63
Q

FVC

A

how much a patient can put out over how every much time

64
Q

A patient with a FEV1/FVC of 70% and a normal FEV1 has

A

stage I COPD.

65
Q

FEV1 gives you the

A

stage of COPD

66
Q

restricted lung is usually

A

smaller than the normal lung

67
Q

Restrictive lung disease

A

There is a variety or collection of pulmonary diseases that result in pulmonary fibrosis, scarring of lung parenchyma and increased recoil and decreased compliance.

  • Restrictive lung diseases generally classified as intrinsic or extrinsic.
68
Q

Intrinsic lung diseases (can’t keep volume in)

A

Asbestosis
* Pneumonitis
* Acute respiratory distress syndrome * Sarcoidosis
* Idiopathic pulmonary fibrosis

69
Q

Idiopathic pulmonary fibrosis is one type of

A

restrictive lung disease with no identified cause.

70
Q

Extrinsic restrictive lung eases

A

Neuromuscular
– Myasthenia gravis- weakness of diaphragm

  • Anatomical (nonmuscular) – Kyphosis- lose compliance of chest wall
  • Volume restricting
    – Obesity
71
Q

Hyperacute protective mechanisms that characterize an asthma attack include all of the following except:

A

Vasoconstriction

72
Q

The primary inflammatory mediators that characterize an asthma attack include:

A

Eosinophils.

73
Q

Which of the following obstructive pulmonary diseases is characterized by hypertrophy of the large airway mucus glands?

A

Chronic bronchitis.

74
Q

Acute-acting mediators released during an asthma attack include all of the following except:

A

Procalcitonin.

75
Q

The characteristics of chronic bronchitis include all of the following except:

A

Characterized by limited mucus production.

76
Q

The characteristics of chronic bronchitis include all of the following except:

A
77
Q

Which of the following is false in regards to the characteristics of emphysema?

A

Airway inflammation is a primary factor of disease.

78
Q

The most sensitive spirometric parameter to detect early airflow limitation is:

A

FEV1/FVC.

79
Q

The most sensitive spirometric parameter to detect early airflow limitation is:

A
80
Q

Intrinsic restrictive lung diseases include all of the following except:

A

The pathology of restrictive lung diseases shares all of the following characteristics except:

81
Q

Intrinsic restrictive lung diseases include all of the following except:

A

The pathology of restrictive lung diseases shares all of the following characteristics except:

82
Q

Intrinsic restrictive lung diseases include all of the following except:

A

Myasthenia gravis.

83
Q

Intrinsic restrictive lung diseases include all of the following except:

A

Myasthenia gravis.

84
Q

Intrinsic restrictive lung diseases include all of the following except:

A

Myasthenia gravis.

84
Q

Intrinsic restrictive lung diseases include all of the following except:

A

Myasthenia gravis.

Pace- Patho (10 decks)

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