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Patho exam 3 > Pulmonary > Flashcards

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

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2
Q

How many bronchiole branches are their before you reach the lungs?

A

26

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3
Q

Pt has 1:1 chest ratio. what might they have?

A

barrel chest - Emphysema

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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

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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

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6
Q

Expiration is passive or active

A

passive

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7
Q

what happens to the diaphragm during expiration?

A

rises

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8
Q

what happens to alveoli pressure during expiration?

A

decreases

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9
Q

what two muscles are involved in forceful expiration?

A

Abdominals Contract and Intercostals Relax

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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�

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11
Q

what is the formula for airflow?

A

change in pressure / resistance

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12
Q

what affects lung compliance?

A

lung distensibility
thoracic cage distensibility
surface tension

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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

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14
Q

what disorders affects compliance?

A

Emphysema
Respiratory distress syndrome
Conditions affecting the joints of the ribs or spinal cord (scoliosis)

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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
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16
Q

What creates the alveolar-capillary membrane?

A

Alveolus + pulmonary capillary

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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

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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

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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

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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

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21
Q

what produces surfactant?

A

granular pneumocytes (type 2)

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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)

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23
Q

what is the tissue layer comprised of?

A

type 1 and type 2

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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

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25
Q

describe type 2 cells?

A

Plump granular pneumocytes
Aid in cellular repair
Produce surfactant for the 1st layer of membrane
Development of surfactant significant factor in premature birth survival

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26
Q

what is surfactant composed of?

A

Detergent-like phospholipoprotein substance
Sphingomyelin
Lecithin (more)

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27
Q

Describe the formation of surfactant’?

A

Hydrophobic heads facing air

Hydrophilic tails in the water

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28
Q

what layer manages the movement of gases?

A

tissue layer - squamous pneumocytes (type 1)

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29
Q

what affect does lecithin have?

A

it makes surfactant more affective

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30
Q

Why are premies born with immature lungs at risk for infant respiratory distress syndrome?

A

The pulmonary system isnt fully developed since it’s the last of the fetal systems to functionally/structurally mature

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31
Q

how can surfactant in premis be measured?

A

-

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32
Q

What is partial pressure?

A

-

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33
Q

what happens when plasma CO2 concentration increases?

A

ventilation has decreased causing pH to go down = respiratory acidosis –> compensated by hyperventilation

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34
Q

A patients respiration

A

-

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35
Q

what compensates for increased ventilation?

A

hypoventilation

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36
Q

what drives ventilation in normal ppl?

A

CO2 levels

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37
Q

whats the normal blood ph?

A

7.35-7.45

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38
Q

whats the normal partial oxygen pressure?

A

80-100mmHg

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39
Q

whats the normal partial CO2 pressure?

A

35-45 mmHg

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40
Q

what is normal bicarb found in the blood?

A

22-26mEq/L

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41
Q

what does ABG consist of?

A

pH, PCO2, PO2, HCO3

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42
Q

What is the 3rd Alveolar-Capillary Membrane known as?

A

Interstitial space

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43
Q

What is found between the basement membrane of alveolar epithelium from basement membrane of capillary endothelium?

A

interstitial fluid

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44
Q

What is interstitial edema?

A

When too much fluid gets into interstitial space -> Space will separate → Making gas exchange more difficult

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45
Q

What is the 4th capillary membrane?

�

A

capillary endothelium

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46
Q

What is found in the 4th layer?

A

wandering macrophages

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47
Q

Wangering macrophages are also known as?

A

Type III cells

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48
Q

What are pores of Kohn? What do they do?

A

Small holes between alveoli

Allow movement of macrophages from one alveolus to another

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49
Q

What is it called when CO2 accumulates in the plasma? and is the ph high or low?

A

hypercapnia aka Respiratory Acidosis

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50
Q

What caused hypercapnia?

A

from hypoventilation

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51
Q

which system of the body requires continuous stimulation from the brainstem?

A

respiratory

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52
Q

what stimulates inspiratory drive in respiration?

A

pons

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53
Q

what controls the regulation of respiration?

A

medullary center

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54
Q

what part of the brain controls voluntary breathing?

A

cerebral cortex

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55
Q

What is the chemical receptor site?

A

peripheral and central chemoreceptors

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56
Q

What chemicals influence central chemoreceptors?

A

just increase CO2 and H+

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57
Q

What chemicals influence peripheral chemoreceptors?

A

decrease in O2 increase CO2 and H+

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58
Q

What respiratory centers in the medulla are stimulated if a pt has respiratory acidosis?

A

peripheral chemoreceptors

central receptors

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59
Q

which is the only chemoreceptor in the medulla that responds to low oxygen?

A

peripheral chemoreceptors

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60
Q

which chemoreceptor stimulates the most response?

A

central chemoreceptors

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61
Q

How does emotional stimuli and pain affect respiration (what part of the brain)?

A

positive/ negative in the hypothalamus

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62
Q

Name the only positive respiratory centers in the medulla

A

peripheral, central, receptors in muscles and joints

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63
Q

Name the only negative respiratory centers in the medulla

A

stretching of the lung, irritant receptors

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64
Q

Name the respiratory centers in the medulla respond to both positive and negative stimuli

A

hypothalamus and cerebral cortex

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65
Q

What kind of impulse did the medullary respiratory center cause?

A

efferent impulse

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66
Q

where are afferent impulses received?

A

medullary respiratory centers

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67
Q

How does the negative feedback mechanism regulate ventilation?

A

central and peripheral chemoreceptor respond to increased PCO2/pH and then the medullary respiratory centers send impulses to the respiratory muscles increases ventilation

68
Q

What responds to increased PCO2 and decreased pH in cerebral spinal fluid?

A

central chemoreceptors

69
Q

How can you determine long standing hypoxia?

A

looking at the digits and measuring sing the angle of clubbing to measure if it’s early middle or serve

70
Q

What are the two forms of cyanosis?

A

Peripheral or central

71
Q

What is peripheral cyanosis related to? Give an example.

A

Related to grams of hemoglobin

Ex: Lupus

72
Q

What is an indication of central cyanosis?

A

finger extremities and the lips

73
Q

A pt is cyanotic what would you see on a CBC to confirm this diagnosis?

A

5g of desaturated hemoglobin or more (less oxygen bound hemoglobin)

74
Q

what other reasons could a patient be cyanotic?

A

blood loss

75
Q

Pt has Polycythemia Vera with 6g of desaturated hemoglobin. Would you consider this patient in trouble/hypoxia? Why?

A

No the pt has more then enough RBC to compensate for the 6g of desaturated hemoglobin

76
Q

what does cyanosis typically indicate?

A

severe hypoxia

77
Q

What does the spirometery test evaluate?

A

Diagnostic spirometer used to evaluate patient’s ability to ventilate during a maximum forced exhale

78
Q

What is vital capacity?

A

Amount of air exhaled after maximum inspiration

79
Q

What is forced vital capacity (FVC)?

A

Volume expired with maximal force

80
Q

What is forced expiratory volume-1 (FEV1)?

A

Amount of air exhaled during the first second of the FVC test

81
Q

What Measures patient’s ability to move air into and out of the lungs?

A

Peak flow meter

82
Q

What can the flow volume loop show?

A

restrictive or obstructive (ex: COPD)

83
Q

how do you determine a child’s personal best?

A

reviewing the recorded measurements 2-3x a day for 2-3 weeks

84
Q

What does a peak flow meter measure?

A

Measures patient’s ability to move air into and out of the lungs

85
Q

Describe what PEFR is and what the 3 levels indicate?

A

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
Q

what is a pulse oximeter?

A

Measures and records the oxygen (O2) saturation of the blood (SpO2)

87
Q

How can injury to the capillary cause pulmonary edema?

A

Increases capillary permeability and disruption of surfactant
movement of fluid and plasma proteins from capillary to intertisial space

88
Q

How can blockage of a lymphatic vessel cause pulmonary edema?

A

Accumulation of fluid

89
Q

How can valvular dysfunction, CAD, or left ventricular dysfunction cause pulmonary edema?

A

it increases left atrial pressure –> increased pulmonary capillary hydrostatic pressure –> excess water in the lungs

90
Q

what is Pulmonary edema?

A
  • Excess water in the lungs
91
Q

pt has increase hydrostatic pressure due to pulmonary edema. what underling condition do they have?

A

Left Ventricular Failure and obstructed lymph vessel

92
Q

pt has pulmonary edema due to decreased vascular oncotic pressure, what caused this?

A

increased capillary permeability

93
Q

what can cause a thrombus?

A

venous stasis, vessel injury, hyper coagulability

94
Q

what is an embolism?

A

a dislodgment of a thrombus

95
Q

what is a PE?

A

Occlusion of portion of pulmonary vasculature

96
Q

what occurs from Occlusion of portion of pulmonary vasculature?

A 
hypoxic vasoconstriction
decreased surfactant 
release of neural humoral substances 
pulmonary edema
Atelectasis
97
Q

what is Atelectasis?

A

not the same as pnemothorax, due to collapse or closure of lung from lack of blood flow to the capillary

98
Q

What is the V/Q ratio of a patient with impaired ventilation and hypoxemia?

A

low V/Q

99
Q

What is the V/Q ratio of a patient with collapsed alveolus due to blocked ventilation and hypoxemia?

A

(very low) Shunt V/Q

100
Q

What damage at the alveolar level will affect V/Q?

A

impaired ventilation
alveolar dead space
Impaired perfusion

101
Q

what will cause high V/Q?

A

impaired perfusion

102
Q

what may or may not be categorized by COPD?

A

asthma

103
Q

what disease are considered COPD?

A

emphysema
chronic bronchitis
bronchiectasis

104
Q

What disease characteristic should you expect with a pt with emphysema and chronic bronchitis?

A

Most patients retain CO2
↓ ↓
Hypoxic with respiratory acidosis

Dyspnea becomes progressively more severe
↓↓
Eventually develop respiratory failure

105
Q

what is asthma? list 4 things

A

Chronic Inflammatory Disorder
Recurrent, reversible episodes of wheezing
Bronchial Hypersensitivity
Heredity component

106
Q

what are the types of asthma?

A

Mild Intermittent-> Mild Persistent -> Moderate Persistent -> Severe Persistent

107
Q

What happens during an allergen or irritant exposure?

A

IL-4, IgE production and mast cell degranulation

108
Q

What mediators would respond to mast cell degranulation?

A

Vasoactive mediators

Chemotactic mediators

109
Q

what would a vasoacitve mediator cause?

A

vasodilatation

110
Q

what would a chemotactic mediator cause that leads to bronchial hyperresponsiveness? (3)

A

-89

111
Q

what is Abnormal permanent enlargement of gas-exchange airways (Acini) known as?

A

emphysema

112
Q

what disease is associated with chronic destructive in alveolar walls?

A

emphysema

113
Q

why is emphysema known as pink puffers?

A

Patients use a large amount of energy to exhale and Cyanosis doesnt appear until late in the disease

114
Q

what are the 4 major distinctive characteristics of emphysema?

A

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
Q

Physical appearance of COPD

A

barrel chest

116
Q

What constitutes chronic bronchitis?

A

Pt has bronchitis at least three months of the year for two consecutive years

117
Q

what is bronchitis?

A

Hypersecretion of mucus and chronic productive cough

118
Q

Why do chronic bronchitis pt have severely inflamed lungs?

A

Trapped mucus in lower respiratory tract

119
Q

T or F - The parietal layer is superficial to the visceral pleura.

A

true

120
Q

Do crackles occur on inhalation or exhalation?

A

inhalation - this is when alveoli collapse and pop back opened

121
Q

What are the functions of the respiratory system?

A

Gas exchange
Acid-base balance
Phonation

122
Q

What is ventilation?

A

Movement of air in and out

123
Q

What is respiration?

A

Exchange of gases at alveoli

124
Q

Name the respiratory tree divisions (7)

A

Trachea

Primary bronchi
Secondary bronchi
Tertiary bronchi

Bronchiole
Terminal bronchiole

Alveoli

125
Q

what does the alveoli branch off of?

A

alveolar duct

126
Q

What does the fusion of alveolar and capillary walls allow?

A

Better/easy diffusion

127
Q

What supplies the alveoli with blood?

A

Cobweb of capillaries surrounding the lung

128
Q

what helps maintain a sterile environment in the lungs?

A

Alveolar Macrophages + Ciliary Current = Sterile Membrane

129
Q

What are some thing you would find surrounding the alveoli?

A

Smooth muscle
Elastic fibers
Capillaries

130
Q

What are the two types of respiratory circulation?

A

Pulmonary circulation

Bronchiole circulation

131
Q

what are the 4 layers of the respiratory membrane?

A
  1. surfactant
  2. tissue layer
  3. interstitial space
  4. capillary endothelium
132
Q

What happens during inspiration?

A

Contraction of Diaphragm (falls), Intercostals
Alveolar Pressure Falls
Air flows into Lungs

133
Q

is inspiration active or passive?

A

active

134
Q

how much is inspired at rest?

A

500ml of Air Inspired

135
Q

how much is inspired during deep breathing?

A

2-3 L (apx 5 in athletes)

136
Q

when does the diaphragm move inferiorly?

A

inspiration

137
Q

Name the sequence of events during inspiration

A

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
Q

Where does negative pressure need to be maintained?

A

within the pleural space

139
Q

what is expiration?

A

Expiration is Normally Passive
Elastic recoil of Diaphragm
Alveolar Pressure Rises

140
Q

what additional muscles are used during forceful respiration?

A

Forceful Expiration = Abdominals Contract and Intercostals Relax

141
Q

what is lung compliance? what does it consist of?

A

= distensibility
surface tension
thoracic cage distensibility
lung distensibility

142
Q

What does carbaaminohemoglobin do?

A

-

143
Q

what percentage of carbon dioxide is transported throughout the body?

A

10% Dissolved in Plasma

20% Carbaminohemoglobin

70% Bicarbonate
�

144
Q

Pt has a lower respiratory tract mucosa becomes severely inflamed with mucus production what is a likely sequelae?

A

Risk of lung infection increases

Pneumonia is common

145
Q

Pooled mucus due to chronic bronchitis impairs what?

A

Pooled mucus impairs ventilation/ gas exchange

146
Q

Which COPD is related to lung fibrosis?

A

Emphysema

147
Q

What could airways obstruction or air trapping result in?

A

Abnorm ventilation perfusion ratio
Hypoxemia
hypoventilation
right heart failure

148
Q

What does alpha antitrypsin?

Breakdown of elastin in CT of lungs

A

Breakdown of elastin in CT of lungs

149
Q

What is a COPD that is associated with with chronic bronchial inflammation caused by obstruction, infection, CF, and systemic disease such as AIDS?

A

bronchiectasis

150
Q

What is bronchiectasis?

A

Persistent, abnormal dilation of bronchi, Elastic and muscular components destroyed

151
Q

Which COPD is associated with chronic productive cough?

A

Bronchiectasis and chronic bronchitis

152
Q

what is it called when you have too much fluid in the alveolar capillary membrane of the lungs?

A

interstitial edema

153
Q

What causes a pnemothorax?

A

Outside air enters because of disruption of chest wall

154
Q

How can you tell its a pleural effusion?

A

Xray and Thoracentesis (Thoracentesis will tell you if its blood or fluid)

�

155
Q

what are type III cells called and where are they located?

A

“Wandering macrophages” (Type III cells ) located in 4th layer

156
Q

how do wandering macrophages get from alveolar to alveolar?

A

pores of kohn

157
Q

What is pleural effusion?

A

Accumulation of fluid in pleural space reducing volume of the lung space

158
Q

what types of fluid shift cause Pleural effusion?

A

Transudative or Exudative

159
Q

whats the difference btwn Transudative or Exudative?

A 
Transudative = watery, CHF
Exudative = protein rich, infection or inflammation
160
Q

what is hemothorax?

A

blood in pleural space

161
Q

what is hydrothorax?

A

water in pleural space

162
Q

what type of fluid shift would result from an infection or blocked blood/lymph vessels?

A

Exudative

163
Q

what type of fluid shift would result from an increase in pressure of the blood vessels or low blood protein?

A

transuduative

164
Q

What causes a pnemothorax?

�

A

Outside air enters because of disruption of chest wall and parietal pleural or lung air enters because of disruption of visceral pleura�.

165
Q

What is Dalton’s law?

A

In a mixture of gases, each gas exerts it’s own pressure as if the other gases are not present

166
Q

What is partial pressure?

A

% of gas X total pressure

167
Q

How do gasses move?

A

Gases move along Partial Pressure Gradient

Patho exam 3 (5 decks)

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