Pulmonary Phys theme 1 Flashcards

1
Q

Name the vascular lung disorders

A

Pulmonary embolism
Pulmonary edema
Pulmonary hypertension
Congenital malformation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Name the restrictive-like lung disorders

A
Interstitial pulmonary fibrosis
sacrcoidosis 
environmental factors
hypersensitivity pneumonitis
certain cancers
pleural effusions & thickening 
Pneumothorax
scoliosis
ankylosing spondylitis
obesity 
neuromuscular disorers
pulmonary edema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Changes seen in a PFT for a person with obstructive lung disorder?

A

lower FEV1 leading to a lower FEV1/FVC (norm value 80%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

changes seen in a person with restrictive like lung disorder

A

dec FVC leading to and inc in FEV1/FVC ratio (norm value 80% you’ll see ~90% here)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what creates the subatmoshperic Ppl?

A

It is created by the tension between the chest wall expanding force, and the lungs collapsing force

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How does the diaphragm contracting begin inspiration?

A

it inc the pleural space-> makes the pleural pressure more negative -> lungs expand-> cause negative alveolar pressure-> causing a gradient btw alveoli and atmosphere-> air flows in

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

be able to describe the respiratory cycle

A

1.06 slide 9-14

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

whats the biggest factor in Airway Resistance?

A

size of radius

the bigger the radius = less resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How does adding branches lower airway resistance?

A

the branches are added in a parallel circuit fashion, which lowers the resistance of the system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What does radial traction do for airways?

A

its mechianically tethered

it inc the diameter which will lower the resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What happens if you lower the radius of of airways?

A

you inc the airway resistance making it more difficult to push air out(dec FEV1), takes a higher press gradient. This is what you see in an obstructive lung disorder (like asthma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Why do you get an occulsion in emphysema during forced expiration?

A

in emphysema you have a reduce alevolar elastic component so you have less recoil force. Has you go up the airway you lose some of your pressure due to airway resistance. You can get to a point that the pleural pressure is actually greater than the airway pressure which is what causes the occulsion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What/How do we overcome pulmonary surface tension?

A

surfactant, which is produce by type 2 pnemocytes, which only cover a small fraction of the alveolar surface area. This is why they have a greater effect on small alveoli from collapsing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is surfactant?

A

mixture of lipids and proteins sim to phospholipids of the membrane. They interpose themselves between water molecules to reduce surface tension.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

whats the importance of reducing surface tension with surfactant?

A

based on size pressure laws air would flow to just bigger alveoli bc of reduced surface tension. Surfactant reduces surface tension of smaller alveoli, kind of evening out the ball field, so air goes into both small and big alveoli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Why does a person with restricted lung disease inc their breath freq?

A

resistricted lung disease inc the work of breath during inspiration. People want to breath at the lowest work needed to breath, so to compensate the inc workload to do normal breath, someone will just inc their breath rate instead of working harder to inflate to normal capacity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How does obstructive lung disorder effect ones work of breathing?

A

it inc the work of breathing during expiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What happens when Pulmonary Pressure goes up?

A

vascular resistance goes down-> pulmonary blood flow goes up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What can cause lace of function to ciliated epithelium in the Respiratory tract?

A
infection (big player)
chemical (alcohol & smoking)
congentital (situs inversus) 
increases pneumonias  (Klebsiella pneumoniae) 
toxins from bacteria -> paralysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Defects in immunity increases incidence of upper respiratory tract infections by what?

A

encapsulated organsisms, especially:
streptococcus pneumoniae
Neisseria meningitidis
Haemophilus influenzae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Defects impact oropharyngeal area causing increase in infection by?

A

Haemophilus meningitidis and Neisseria influenzae

22
Q

Infection of the upper respiratory tract that cause inflammation?

A

sinusitis (bacterial), otitis media (fungal), pharyngitis (viral)

23
Q

infection of the lower respiratory?

A

pneumonia

24
Q

Describe the TLR signaling pathway?

A

TLRs recognize PAMPs -> MyD88 activates NFKappaB-> induces the transcription of cytokines

25
Q

What are the cytokines NFKappaB induces the transcription of?

A

IL-1
IL-2
THF alpha (it is a type 1 interferon seen with viral infect) + IL-6 {fever}
IL-8 (neutrophil inflammation)

26
Q

TLRs look for extracellular and intracellular organisms. What is a intracellular TLRs looking for?

A

dsRNA
ssRNA
basically viral genome

27
Q

What does TNF-alpha do?

A

fever, endothelial permeabiltiy, (hypovolemia) (effusion), coagulation
used in viral infections

28
Q

What does IL-1 do

A

fever, vasodilation, adhesion factors

29
Q

What does IL-8 do? aka cdc8

A

neutrophil infiltration and activator=PUS

also causes bands in neutrophils

30
Q

what does IL-6 do?

A

fever, acute inflammatory protein synthesis, B-cell growth, and segue to granuloma formation

31
Q

What does IL-2 do?

A

initiate T-cell activation , its the bridge between innate and adaptive immune response

32
Q

What causes a left shift in WBC diffentions?

A

IL-8, it will start off as an innate response and then more than likely switch over to a TH17 response, if switch to a TH1 it will have a spike in neutrophils at the beginning and then lower the count

You have an intracellular pathogen

33
Q

Describe the process of Phagocytosis and what it does after digestion?

A

microbes bind to phagocyte -> membrane enclose forming phagosome-> it fuses with a lysosome-> digest the microbe by ROS, NO, and lysosomal enzymes (in the phagolysosome) -> the broken down peptides are sent to the membrane of cell as MHC2 antigen-> the APC go to lymph tissue to activate CD 4 + T cells

34
Q

What is pus in the lungs called?

A

empyema- some you leave alone other you evacuate

formed by innate and TH17 responses

35
Q

What activates a Classical Pathway TH1 response?

A

IFN-gamma….. fights microbials (bacteria)

36
Q

What activates the alternate pathway TH2?

A

IL-4 & IL-13…… fights parasiteds

37
Q

What activates a TH17 response and what does it attack?

A

TGF-beta, IL-6, IL-23

it attacks extracellular bacteria and fungi

38
Q

Describe the TH2 airway inflammation pathway?

A

APC-T-cell and IL-4 (from basophil) start the process. TH2 release IL-5, IL-4, IL-13. IL-5 cause make and release of eosinophils. IL-4 cause b cell isotype switch to make IgE-> binds to mast cells causing the release of cytokines. IL-5 also cause degranulation of eosinphill in the tissue. IL-13 cause smm hyper reactivity, goblet cell hyperplasia & mucus transcript and translation and chemokine production

39
Q

what does histamine (in mast cells) do?

A

cause bronchoconstriction, and vasodilation

40
Q

What do leukotrienes in mast cells do?

A

inc microvascular permeability, stimulate secretion of mucus, contraction of airway smooth muscle

41
Q

What cause CD4 /TH1 and CD4/ TH17 responses

A

atypical pneumonias, tuberculosis, emphyzema granulomas, and fungal

42
Q

How does chronic TH17 response lead to emphysema?

A

chronic recruitment of neutrophils to the lungs-> prd elastace and metabulite proteases-> loss elastisity of the lung-> leads to emphysema

43
Q

When do you see a CD 8+ response?

A

viral infection and certain cancers

44
Q

What do inhaled corticosteroids do? and what do they work on?

A

They reduce inflammation by inhibiting transcription of pro-inflammatory gene transcription
affects helper CD4+ t-cells and in asthma TH2 cells

45
Q

easiest way to distinguish between Asthma and COPD?

A

PFT post brochodilator
If asthma the FEV1 will need to improve by 12%
If COPD the bronchodilator won’t have any improvement in FEV1. The FEV1/FVC will be

46
Q
why are these test ran in COPD patents?
Xray
Lung Vol and diffusion capacity 
Oximetry and ABG
Alpha-1 antitrypis def screening
A

to see if have cancer
the severity of COPD
evaluate patents O2 sat to see if need to be put on supplemental O2
On caucasian decent under 45, bc can give them a drug to boost alpha-1 antitrypsin to build up in alveoli

47
Q

What is the therapeutic treatments for COPD?

A
Bronchodilators, as needed to prevent or reduce symptoms 
beta2 agonist (long or short term), anticholinergics, theophylline or a combination of them
48
Q

inhaled corticosteroids are also used to treat COPD. What are the big side effects?

A

an inc risk of pneumonia

also withdrawal from this treatment may lead to exacerbation in some patents

49
Q

What is a form of surgery shown to improve COPD?

A

Lung volume reduction surgery. It only really helps upper-lobe predominant emphysema and low exercise capacity

50
Q

Name the obstructive lung disorders

A
Asparate something
COPD (emphysema, chronic bronchitis)
Ashtma
Anaphylaxis
Pulmonary edema
Cystic fibrosis 
Pneumonia
Neoplasm
peribronchial edema