Pulmonary Flashcards
1
Q
whats the difference btwn ventilation and respiration?
A
respiration is gas exchange at alveoli and ventilation can be seen as in and out flow, a component of respiration
2
Q
How many bronchiole branches are their before you reach the lungs?
A
26
3
Q
Pt has 1:1 chest ratio. what might they have?
A
barrel chest - Emphysema
4
Q
what is boyles law?
A
Inverse Relationship Between Volume and Pressure When Temperature Constant
an Increase or Decrease in Lung Volume Results in Inspiration and Expiration
5
Q
what happens in the pleural cavity during inhalation?
A
diaphragm flattens
thoracic cavity increases
intrapulmonary volume increases, intrapulmonary pressure drops (-1)
air flows into lungs down its pressure gradient until intrapulmonary pressure is 0
6
Q
Expiration is passive or active
A
passive
7
Q
what happens to the diaphragm during expiration?
A
rises
8
Q
what happens to alveoli pressure during expiration?
A
decreases
9
Q
what two muscles are involved in forceful expiration?
A
Abdominals Contract and Intercostals Relax
10
Q
what happens during expiration?
A
Elastic recoil of Diaphragm
Alveolar Pressure Rises �
Thoracic cavity volume decreases
Intrapulmonary pressure rises (by +1 mm Hg)
Air flows out of lungs down pressure gradient until pressure is 0�
11
Q
what is the formula for airflow?
A
change in pressure / resistance
12
Q
what affects lung compliance?
A
lung distensibility
thoracic cage distensibility
surface tension
13
Q
whats the difference between having lower or greater compliance?
A
The lower the compliance → the more exertion required for expansion
The greater the compliance → the less exertion required
14
Q
what disorders affects compliance?
A
Emphysema
Respiratory distress syndrome
Conditions affecting the joints of the ribs or spinal cord (scoliosis)
15
Q
Compare good compliance and poor compliance?
A
Good Compliance
Normal breathing at rest
Supply and demand for muscle work balanced
Poor Compliance Normal breathing at rest Use of accessory muscles Increased demand for energy Just breathing leads to exhaustion
16
Q
What creates the alveolar-capillary membrane?
A
Alveolus + pulmonary capillary
17
Q
Describe the position/ location of the alveolus and pulmonary capillaries?
A
Each alveolus surrounded by pulmonary capillary while pulmonary capillaries cover external surfaces of alveoli
18
Q
What is the function of the alveolar-capillary membrane?
A
Alveolar-capillary membrane provides interface between respiratory and cardiovascular systems (blood)
Enhances gas exchange
19
Q
Each adult has how many alveoli? how large is the surface area?
A
Adults have 300–600 million alveoli &
50-100 m2 surface area for O2 diffusion into about 280 billion capillaries
20
Q
what are the layers of the capillary membrane?
A
1st layer - Phospholipid surfactant layer
2nd layer - tissue
3rd layer - interstitial space
4th layer - capillary endothelium
21
Q
what produces surfactant?
A
granular pneumocytes (type 2)
22
Q
what does surfactant do?
A
Lowers surface tension of alveolar walls
Keeps alveolar walls from collapsing with exhalation
Surface tension draws fluid from adjacent capillaries to alveoli (making them wet)
23
Q
what is the tissue layer comprised of?
A
type 1 and type 2
24
Q
Describe type 1 cells?
A
Squamous pneumocytes
Make up (95%) of alveolar surface
Thin pancake-like cells
Allow easy movement of gas molecules
25
describe type 2 cells?
Plump granular pneumocytes
Aid in cellular repair
Produce surfactant for the 1st layer of membrane
Development of surfactant significant factor in premature birth survival
26
what is surfactant composed of?
Detergent-like phospholipoprotein substance
Sphingomyelin
Lecithin (more)
27
Describe the formation of surfactant'?
Hydrophobic heads facing air
| Hydrophilic tails in the water
28
what layer manages the movement of gases?
tissue layer - squamous pneumocytes (type 1)
29
what affect does lecithin have?
it makes surfactant more affective
30
Why are premies born with immature lungs at risk for infant respiratory distress syndrome?
The pulmonary system isnt fully developed since it’s the last of the fetal systems to functionally/structurally mature
31
how can surfactant in premis be measured?
-
32
What is partial pressure?
-
33
what happens when plasma CO2 concentration increases?
ventilation has decreased causing pH to go down = respiratory acidosis --> compensated by hyperventilation
34
A patients respiration
-
35
what compensates for increased ventilation?
hypoventilation
36
what drives ventilation in normal ppl?
CO2 levels
37
whats the normal blood ph?
7.35-7.45
38
whats the normal partial oxygen pressure?
80-100mmHg
39
whats the normal partial CO2 pressure?
35-45 mmHg
40
what is normal bicarb found in the blood?
22-26mEq/L
41
what does ABG consist of?
pH, PCO2, PO2, HCO3
42
What is the 3rd Alveolar-Capillary Membrane known as?
Interstitial space
43
What is found between the basement membrane of alveolar epithelium from basement membrane of capillary endothelium?
interstitial fluid
44
What is interstitial edema?
When too much fluid gets into interstitial space -> Space will separate → Making gas exchange more difficult
45
What is the 4th capillary membrane?
| �
capillary endothelium
46
What is found in the 4th layer?
wandering macrophages
47
Wangering macrophages are also known as?
Type III cells
48
What are pores of Kohn? What do they do?
Small holes between alveoli
| Allow movement of macrophages from one alveolus to another
49
What is it called when CO2 accumulates in the plasma? and is the ph high or low?
hypercapnia aka Respiratory Acidosis
50
What caused hypercapnia?
from hypoventilation
51
which system of the body requires continuous stimulation from the brainstem?
respiratory
52
what stimulates inspiratory drive in respiration?
pons
53
what controls the regulation of respiration?
medullary center
54
what part of the brain controls voluntary breathing?
cerebral cortex
55
What is the chemical receptor site?
peripheral and central chemoreceptors
56
What chemicals influence central chemoreceptors?
just increase CO2 and H+
57
What chemicals influence peripheral chemoreceptors?
decrease in O2 increase CO2 and H+
58
What respiratory centers in the medulla are stimulated if a pt has respiratory acidosis?
peripheral chemoreceptors
| central receptors
59
which is the only chemoreceptor in the medulla that responds to low oxygen?
peripheral chemoreceptors
60
which chemoreceptor stimulates the most response?
central chemoreceptors
61
How does emotional stimuli and pain affect respiration (what part of the brain)?
positive/ negative in the hypothalamus
62
Name the only positive respiratory centers in the medulla
peripheral, central, receptors in muscles and joints
63
Name the only negative respiratory centers in the medulla
stretching of the lung, irritant receptors
64
Name the respiratory centers in the medulla respond to both positive and negative stimuli
hypothalamus and cerebral cortex
65
What kind of impulse did the medullary respiratory center cause?
efferent impulse
66
where are afferent impulses received?
medullary respiratory centers
67
How does the negative feedback mechanism regulate ventilation?
central and peripheral chemoreceptor respond to increased PCO2/pH and then the medullary respiratory centers send impulses to the respiratory muscles increases ventilation
68
What responds to increased PCO2 and decreased pH in cerebral spinal fluid?
central chemoreceptors
69
How can you determine long standing hypoxia?
looking at the digits and measuring sing the angle of clubbing to measure if it's early middle or serve
70
What are the two forms of cyanosis?
Peripheral or central
71
What is peripheral cyanosis related to? Give an example.
Related to grams of hemoglobin
| Ex: Lupus
72
What is an indication of central cyanosis?
finger extremities and the lips
73
A pt is cyanotic what would you see on a CBC to confirm this diagnosis?
5g of desaturated hemoglobin or more (less oxygen bound hemoglobin)
74
what other reasons could a patient be cyanotic?
blood loss
75
Pt has Polycythemia Vera with 6g of desaturated hemoglobin. Would you consider this patient in trouble/hypoxia? Why?
No the pt has more then enough RBC to compensate for the 6g of desaturated hemoglobin
76
what does cyanosis typically indicate?
severe hypoxia
77
What does the spirometery test evaluate?
Diagnostic spirometer used to evaluate patient’s ability to ventilate during a maximum forced exhale
78
What is vital capacity?
Amount of air exhaled after maximum inspiration
79
What is forced vital capacity (FVC)?
Volume expired with maximal force
80
What is forced expiratory volume-1 (FEV1)?
Amount of air exhaled during the first second of the FVC test
81
What Measures patient’s ability to move air into and out of the lungs?
Peak flow meter
82
What can the flow volume loop show?
restrictive or obstructive (ex: COPD)
83
how do you determine a child's personal best?
reviewing the recorded measurements 2-3x a day for 2-3 weeks
84
What does a peak flow meter measure?
Measures patient’s ability to move air into and out of the lungs
85
Describe what PEFR is and what the 3 levels indicate?
Peak expiratory flow rate
Green- good take meds
Yellow- take meds see if it improves if not then get medical help
Red- Get medical help
86
what is a pulse oximeter?
Measures and records the oxygen (O2) saturation of the blood (SpO2)
87
How can injury to the capillary cause pulmonary edema?
Increases capillary permeability and disruption of surfactant
movement of fluid and plasma proteins from capillary to intertisial space
88
How can blockage of a lymphatic vessel cause pulmonary edema?
Accumulation of fluid
89
How can valvular dysfunction, CAD, or left ventricular dysfunction cause pulmonary edema?
it increases left atrial pressure --> increased pulmonary capillary hydrostatic pressure --> excess water in the lungs
90
what is Pulmonary edema?
- Excess water in the lungs
91
pt has increase hydrostatic pressure due to pulmonary edema. what underling condition do they have?
Left Ventricular Failure and obstructed lymph vessel
92
pt has pulmonary edema due to decreased vascular oncotic pressure, what caused this?
increased capillary permeability
93
what can cause a thrombus?
venous stasis, vessel injury, hyper coagulability
94
what is an embolism?
a dislodgment of a thrombus
95
what is a PE?
Occlusion of portion of pulmonary vasculature
96
what occurs from Occlusion of portion of pulmonary vasculature?
```
hypoxic vasoconstriction
decreased surfactant
release of neural humoral substances
pulmonary edema
Atelectasis
```
97
what is Atelectasis?
not the same as pnemothorax, due to collapse or closure of lung from lack of blood flow to the capillary
98
What is the V/Q ratio of a patient with impaired ventilation and hypoxemia?
low V/Q
99
What is the V/Q ratio of a patient with collapsed alveolus due to blocked ventilation and hypoxemia?
(very low) Shunt V/Q
100
What damage at the alveolar level will affect V/Q?
impaired ventilation
alveolar dead space
Impaired perfusion
101
what will cause high V/Q?
impaired perfusion
102
what may or may not be categorized by COPD?
asthma
103
what disease are considered COPD?
emphysema
chronic bronchitis
bronchiectasis
104
What disease characteristic should you expect with a pt with emphysema and chronic bronchitis?
Most patients retain CO2
↓ ↓
Hypoxic with respiratory acidosis
Dyspnea becomes progressively more severe
↓↓
Eventually develop respiratory failure
105
what is asthma? list 4 things
Chronic Inflammatory Disorder
Recurrent, reversible episodes of wheezing
Bronchial Hypersensitivity
Heredity component
106
what are the types of asthma?
Mild Intermittent-> Mild Persistent -> Moderate Persistent -> Severe Persistent
107
What happens during an allergen or irritant exposure?
IL-4, IgE production and mast cell degranulation
108
What mediators would respond to mast cell degranulation?
Vasoactive mediators
| Chemotactic mediators
109
what would a vasoacitve mediator cause?
vasodilatation
110
what would a chemotactic mediator cause that leads to bronchial hyperresponsiveness? (3)
-89
111
what is Abnormal permanent enlargement of gas-exchange airways (Acini) known as?
emphysema
112
what disease is associated with chronic destructive in alveolar walls?
emphysema
113
why is emphysema known as pink puffers?
Patients use a large amount of energy to exhale and Cyanosis doesnt appear until late in the disease
114
what are the 4 major distinctive characteristics of emphysema?
Chronic destructive changes in alveolar walls
Airways collapse during expiration
Loss of Elastic Recoil (Irreversible enlargement of alveolar air spaces)
Chronic inflammation promotes lung fibrosis
�
�
115
Physical appearance of COPD
barrel chest
116
What constitutes chronic bronchitis?
Pt has bronchitis at least three months of the year for two consecutive years
117
what is bronchitis?
Hypersecretion of mucus and chronic productive cough
118
Why do chronic bronchitis pt have severely inflamed lungs?
Trapped mucus in lower respiratory tract
119
T or F - The parietal layer is superficial to the visceral pleura.
true
120
Do crackles occur on inhalation or exhalation?
inhalation - this is when alveoli collapse and pop back opened
121
What are the functions of the respiratory system?
Gas exchange
Acid-base balance
Phonation
122
What is ventilation?
Movement of air in and out
123
What is respiration?
Exchange of gases at alveoli
124
Name the respiratory tree divisions (7)
Trachea
Primary bronchi
Secondary bronchi
Tertiary bronchi
Bronchiole
Terminal bronchiole
Alveoli
125
what does the alveoli branch off of?
alveolar duct
126
What does the fusion of alveolar and capillary walls allow?
Better/easy diffusion
127
What supplies the alveoli with blood?
Cobweb of capillaries surrounding the lung
128
what helps maintain a sterile environment in the lungs?
Alveolar Macrophages + Ciliary Current = Sterile Membrane
129
What are some thing you would find surrounding the alveoli?
Smooth muscle
Elastic fibers
Capillaries
130
What are the two types of respiratory circulation?
Pulmonary circulation
| Bronchiole circulation
131
what are the 4 layers of the respiratory membrane?
1. surfactant
2. tissue layer
3. interstitial space
4. capillary endothelium
132
What happens during inspiration?
Contraction of Diaphragm (falls), Intercostals
Alveolar Pressure Falls
Air flows into Lungs
133
is inspiration active or passive?
active
134
how much is inspired at rest?
500ml of Air Inspired
135
how much is inspired during deep breathing?
2-3 L (apx 5 in athletes)
136
when does the diaphragm move inferiorly?
inspiration
137
Name the sequence of events during inspiration
Contraction of inspiratory muscles
Thoracic cavity volume increase
Lungs stretch (intrapulmoary volume increases)
Intrapulmonary pulmonary drops -1mm Hg
Air/gases flow into lung (down pressure gradient) until intrapulmonary is equal to atm
138
Where does negative pressure need to be maintained?
within the pleural space
139
what is expiration?
Expiration is Normally Passive
Elastic recoil of Diaphragm
Alveolar Pressure Rises
140
what additional muscles are used during forceful respiration?
Forceful Expiration = Abdominals Contract and Intercostals Relax
141
what is lung compliance? what does it consist of?
= distensibility
surface tension
thoracic cage distensibility
lung distensibility
142
What does carbaaminohemoglobin do?
-
143
what percentage of carbon dioxide is transported throughout the body?
10% Dissolved in Plasma
20% Carbaminohemoglobin
70% Bicarbonate
�
144
Pt has a lower respiratory tract mucosa becomes severely inflamed with mucus production what is a likely sequelae?
Risk of lung infection increases
| Pneumonia is common
145
Pooled mucus due to chronic bronchitis impairs what?
Pooled mucus impairs ventilation/ gas exchange
146
Which COPD is related to lung fibrosis?
Emphysema
147
What could airways obstruction or air trapping result in?
Abnorm ventilation perfusion ratio
Hypoxemia
hypoventilation
right heart failure
148
What does alpha antitrypsin?
| Breakdown of elastin in CT of lungs
Breakdown of elastin in CT of lungs
149
What is a COPD that is associated with with chronic bronchial inflammation caused by obstruction, infection, CF, and systemic disease such as AIDS?
bronchiectasis
150
What is bronchiectasis?
Persistent, abnormal dilation of bronchi, Elastic and muscular components destroyed
151
Which COPD is associated with chronic productive cough?
Bronchiectasis and chronic bronchitis
152
what is it called when you have too much fluid in the alveolar capillary membrane of the lungs?
interstitial edema
153
What causes a pnemothorax?
Outside air enters because of disruption of chest wall
154
How can you tell its a pleural effusion?
Xray and Thoracentesis (Thoracentesis will tell you if its blood or fluid)
�
155
what are type III cells called and where are they located?
“Wandering macrophages” (Type III cells ) located in 4th layer
156
how do wandering macrophages get from alveolar to alveolar?
pores of kohn
157
What is pleural effusion?
Accumulation of fluid in pleural space reducing volume of the lung space
158
what types of fluid shift cause Pleural effusion?
Transudative or Exudative
159
whats the difference btwn Transudative or Exudative?
```
Transudative = watery, CHF
Exudative = protein rich, infection or inflammation
```
160
what is hemothorax?
blood in pleural space
161
what is hydrothorax?
water in pleural space
162
what type of fluid shift would result from an infection or blocked blood/lymph vessels?
Exudative
163
what type of fluid shift would result from an increase in pressure of the blood vessels or low blood protein?
transuduative
164
What causes a pnemothorax?
| �
Outside air enters because of disruption of chest wall and parietal pleural or lung air enters because of disruption of visceral pleura�.
165
What is Dalton’s law?
In a mixture of gases, each gas exerts it’s own pressure as if the other gases are not present
166
What is partial pressure?
% of gas X total pressure
167
How do gasses move?
Gases move along Partial Pressure Gradient
