Pulmonary Flashcards

Question

components of surfactant

Answer 1

50% phosphatidylcholine disaturated 20% phosphatidylcholine monosaturated 8% SP A, B, C, D 8% neutral lipids 8% phosphatidyl glyerol 6% other

Answer 2

both = A and B only type II = C and D

Answer 3

A = 10 B = 2 C = 8 D = 10

Answer 4

A =early third B= end of first C = end of first D = latest in third

Answer 5

hydrophillic = A and D (both collectins) hydrophobic = B and C

Answer 6

A, B, and C

Answer 7

tubular myelin formation phospholipid uptake and inhibits its secretion host defense: opsonization, inflammation modulation *helps regulate the expression and uptake of surfactant*

Answer 8

SURFACTANT FUNCTION tubular myelin formation surface absorption of phospholipids

Answer 9

SURFACTANT FUNCTION surface absorption of phospholipids

Answer 10

- host defense: -- opsonization -- inflammation modulation -- antioxidant - surfactant lipid homeostasis - regulates reuptake and recycling

Answer 11

AR transport of lipids --> lack of DPPC and PG --> decreased lamellar bodies

Answer 12

1. transport 2. lamellar storage 3. secretion 4. adsorption 5. turnover 6. recycling 7. clearance

Answer 13

diabetes rh immunization 2nd born twin male c-sec prematurity insulin tgf beta androgen

Answer 14

peaks around 35 then drops present before phosphotidylglycerol

Answer 15

does NOT reflect lung maturity decreases after 32 weeks

Answer 16

lecithin/sphingomyelin

Answer 17

increases with GA reflects lung maturity > 2 = mature; 2 at 35 weeks

Answer 18

increases last; after 34-35 weeks not necessary for surfactant function reflects lung maturity

Answer 19

if AF mixed with ethanol forms foam then phosphatidyl glycerol is present suggesting mature lung high false negative

Answer 20

detects unraveling or solubilization of lamellar bodies in amniotic fluid if mature lung tissue

Answer 21

**P = 2T/r** P = pressure to resist alveolar collapse T = surface tension r - alverolar radius

Answer 22

P1V1 = P2V2

Answer 23

lung overinflation --> inspiration stops as pulmonary stretch receptors in smooth muscle send signals to afferent neural input in medulla causing vagal nerve to inhibit inspiration

Answer 24

zone 3 Pa > Pv > PA

Answer 25

zone 1 or 2 leading to decreased pulmonary venous compression and decreased pulmonary blood flow

Answer 26

zone 4 with increase PVR and decreased pulmonary ventilation and alveolar collapse

Answer 27

(arterial CO2 - Expired CO2)/arterial CO2 X TV

Answer 28

change P/change flow

Answer 29

(O2 content pulm capillary - O2 content systemic artery)/ (O2 content pulm capillary - O2 content mixed venous)

Answer 30

25% chest wall 55% airway 20% lung tissue usually: 40-55 cm H20/L/s

Answer 31

* 50% nasal * rest first few generation of bronchi * distal contribute very little

Answer 32

(change P x pi x r^4)/(8 x length x viscosity)

Answer 33

change V/change P

Answer 34

change P / change V

Answer 35

work x force

Answer 36

resistance x compliance

Answer 37

time for alveoli to discharge 63%

Answer 38

alveoli discharges 86%

Answer 39

alveoli discharges 95%

Answer 40

RR residual volume MV alveolar ventilation = TV - deadspace x RR chest wall compliance lung tissue resistance oxygen consumption

Answer 41

TV TLC IC VC time constant lung compliance - neonates stiffer lungs muscle strength and endurance

Answer 42

dead space FRC

Answer 43

severe anemia

Answer 44

severe V/Q mismatch high altitude

Answer 45

CO poisoning

Answer 46

O2 bound to Hb + dissolved O2 {1.34 x Hb X O2 sat} + {0.003 x paO2}

Answer 47

percentage of heme binding sites that are saturated with O2

Answer 48

pAO2 - paO2 = [FiO2 x (Pb - pH20)] - {paCO2 / R} - paO2 Pb = 760 pH20 = 47 R = 0.8

Answer 49

CO x O2 content = CO x (O2 bound to Hb + dissolved O2)

Answer 50

O2 delivered to tissue - O2 returning to heart = blood flow x O2 arterial - blood flow x O2 venous = blood flow (O2 artery - O2 venous) = CO x [Hb] x 1.34 (O2 artery - O2 venous)

Answer 51

1. increased caloric intake 2. decreased temp 3. neonate > adult 4. term > preterm 5. AGA > SGA

Answer 52

acidosis higher paCO2 increased adult Hb increased temp increased 2,3 DPG

Answer 53

**bohr** = changes in **O2** **bound** to Hb based on pCO2 **haldane**= change in **CO2** **bound** to Hb based on amount O2

Answer 54

(MAP x FiO2)/postductal paO2 x 100

Answer 55

get to PIP faster

Answer 56

* **bulk convection** - bulk axial gas flow * **pendelluft** - gas moving between neighboring alveoli due to different time constants * **asymmetric velocity** * **taylor dispersion** - parabolic movement - increased area for diffusion * **molecular diffusion**- transport of gases across alveoli

Answer 57

1. **expiration type** : HFOV - active expiration (less gas trapping) HJV = passive 2. **inspiration time** : HFOV 3. **expiration time** : HJV 4. **frequency** HJV 4-11; HFOV 3-15 5. **fixed** inspiratory time HFOV **adjustable** with HJV 6. **sigh breaths** with HJV not HFOV 7. **TV** independent of frequency with HJV not HFOV

Answer 58

GBS E coli klebsiella listeria

Answer 59

s.aureus pseudomonas fungal chlamydia

Answer 60

supraglottic - worsens with inspiration laryngeal - fixed so no change intrathoracic - worsens with expiration

Answer 61

1. double aortic arch (40%) from right and left 4th branchial arch 2. right AoA with ligamentous arteriosum/PDA (30%) - persistence of right 4th branchial arch

Answer 62

1. aberrant right subclavian artery (20%); rSCA from descending aorta 2. anomalous origin of the innominate artery (10%) 3. aberrant LPA (rare)

Answer 63

R > L > bilateral

Answer 64

bypasses lymphatic system

Answer 65

mild vasoconstriction of splanchnics???

Answer 66

LUL 45% RML 30% RUL 20%

Answer 67

CPAM = yes BPS = no

Answer 68

CPAM = pulmonary circulation BPS = anomolous systemic vessels - ie aorta

Answer 69

0 rare 1 MCC 50-70% 2 20-40% 3 10% 4 rare

Answer 70

0 early 1 7-10wk 2 3rd wk 3 26-28d 4 ??

Answer 71

0 very small, all lobes (upper tracheobronchial tree) 1 large, usually just 1 2 multiple small 3 very large microcystic entire lobe or multiple lobes 4 large

Answer 72

type 1 3 and 4

Answer 73

0 and 1 ciliated pseudostratified 2 ciliated cuboid 3 nonciliated cuboid 4 nonciliated flattened mucus cells in type 0 and 1 only

Answer 74

excellent 1 and 4 - excision is curative poor 0 and 2 for associated anomalies poor 3 because of pulmonary hypoplasia

Answer 75

anomalous budding of foregut leading to cystic mass that communicates with airway central or peripheral may be posterior to trachea

Answer 76

primary (tri 21, noonan, turner) secondary (HLHS, thoracic duct agenesis, intrauterine infection) failure of lymphatic vessel regression at 20 weeks or lymphatic obstruction poor prognosis

Answer 77

nonfunctioning lung tissue without communication with tracheobronchial tree

Answer 78

intralobar 75% (lower > upper, L > R); 10-20% risk anomalies extralobar 25% (L>R often between LLL and diaphragm); 40-60% risk of anomalies

Answer 79

inadequate vascularization of alveoli with decreased number of capillaries adjacent to alveoli malaligned pulmonary veins

Answer 80

carbonic anhydrase inhibitor inhibits NaHCO3 reabsorption acts on proximal tubule

Answer 81

blocks active Cl transport ascending loop of henle

Answer 82

inhibits NaCl reabsorption acts on distal tubule inhibits pancreatic release of insulin; risk of hyperglycemia

Answer 83

antagonist of aldosterone acts on collecting duct K sparing

Answer 84

1. transport SP B and SPC into multivesicular bodies 2. lamellar storage 3. secretion into alveolar sub space and interact with SP-A to form tubular myelin reservoir 4. adsorption + film creation to reduce tension 5. turnover by endocytosis by alveolar type II cells 6. recycling into multivesicular and lamellar bodies 7. alveolar macrophages clear and catabolize surfactant remnants

Answer 85

mycophenolate mofetil, allopurinol, and lithium

Answer 86

Fryns Denys Drash Cornelia de Lange Marfan spondylocostal dysostosis craniofrontonasal syndrome

Answer 87

Conventional ventilation: Q ∝ f × VT HFV (jet and oscillatory): Q ∝ f × (VT)2

Answer 88

Prostaglandin

Answer 89

disruption of normal alveolar and vascular development with subsequent diffuse alveolar and capillary hypoplasia

Answer 90

121ins2 SFTB gene chr 2 N. Euro

Answer 91

- stimulation **medullary** respiratory center - increased sensitivity to **CO2** - diaphragmatic contractility - antagonism **adenonsine 1+2 R** in brain > inhibit **phosphodiesterase** > increase **cAMP** and intracellular Ca release - upregulates **GABA-R**

Answer 92

**annexin A1** - decreased **phospholipid A2**--> decreased PG, thromboxane, PC, leukotrienes - suppression **COX1/2** - regulation of surfactant production - **antioxidant** production - enhanced **adrenergic** activity

Pulmonary Flashcards

(121 cards)