Quiz 3 Material pt 2 Flashcards
How can measured FEV and FVC obtained from spirometry differentiate obstruction from restriction?
Obstruction results in a lower FEV/FVC ratio, while restriction results in a proportional decrease in both FEV and FVC, with a normal ratio
Understand the following lung capacities pictured
What two primary variables determine air resistance in a tube (used in airway resistance)?
length and radius of tube
Which of the two primary variables in calculating air resistance has a greater importance? Why?
radius, because mathematically it is raised to the 4th power
Where is blood flow/perfusion (Q) highest in the lung?
the base of the lung
What is a normal V/Q ratio?
0.8
What is dead space?
Area of the lung/airways that does not participate in gas exchange; V/Q = infinity
What is the difference between anatomic and physiologic dead space?
Anatomic is present in all humans and is about 150ml, physiologic is present in individuals with damaged alveoli
What is a shunt?
Gas exchange is not possible due to lack of ventilation of area; V/Q = 0
What is the paO2 and paCO2 of mixed venous blood?
paO2 = 40mmHg
paCO2 = 46mmHg
What is the paO2 and paCO2 of systemic arterial blood?
paO2 = 100mmHg
paCO2 = 40mmHg
What is the Bohr effect associated with?
Increased CO2, decreased pH, increased temperature, and increased 2,3-DPG
What is the Haldane effect?
When less O2 is bound to Hg, its affinity for CO2 will increase
What innervates the costal parietal pleura?
intercostal nerves
What innervates the diaphragmatic parietal pleura?
the phrenic nerve
What innervates the mediastinal parietal pleura?
the phrenic nerve
What innervates the viscera parietal pleura?
visceral sensory nerves via the vagus nerve
What is the pathology of pneumothorax?
Pressure in the lungs equalizes with the pleural space, causing lung collapse
What is the meaning of the acronym RALS?
RIGHT PA is ANTERIOR to bronchus, LEFT PA is SUPERIOR to bronchus
What spinal cord levels provide sympathetic innervation of the lungs?
T1-T5
What is the postsynpatic nerve that innervates the lungs?
the cardiopulmonary splanchnic nerve
As AMP levels rise and activate AMPK, what is the effect on metabolism?
Catabolic metabolism is activated
What are two main cellular effects of mitochondrial uncoupling?
Increased NADPH oxidation and O2 consumption
What is the mechanism of mitochondrial uncoupling?
Since ATP generation is uncoupled from the ETC, cells will upregulate glycolysis, TCA, and ETC
What vitamin is necessary for NAD cofactor formation?
Niacin (vitamin B3)
What vitamin is necessary for FAD cofactor formation?
Riboflavin (vitamin B2)
What vitamin is necessary to make Coenzyme A?
Pantothenic acid (vitamin B5)
What vitamin is necessary for a-ketoglurate dehydrogenase function?
Thiamine (vitamin B1)
What two prominant conditions can result from vitamin B1 deficiency?
Wernicke encephalopathy and Korsakoff syndrome
How is Wernicke encephalopathy characterized?
confusion and loss of mental activity that can progress to coma and death
How is Korsakoff syndrome characterized?
Long term memory loss due to vitamin B1 deficiency
Referred pain from the phrenic nerve might appear in which dermatomes?
C3-C5
Which pulmonary cell is most easily dysregulated and overactive in cases of chronic smoking?
alveolar macrophages (dust cells)
What is the pathology of RSV (respiratory syncytial virus)?
the virus binds to the epithelial cells and causes necrosis and ciliary dysfunction; inflammation leads to edema, and resistance to flow causes wheezing
What characterizes emphysema?
large alveoli and increased compliance (large, deflated, and low elastic recoil)
What are the two main functions of club cells in the lungs?
They act as respiratory exocrine cells, and can serve as stem cells to mitigate damage (they represent 80% of respiratory epithelium in bronchioles)
Where does the sympathetic innervation of kidney arise from the spinal cord?
T10-T12
What nerve supplies sympathetic innervation to the kidney?
The lesser or least splanchnic nerves
What nerve supplies parasympathetic innervation to the kidney?
There is no PS innervation of kidney
What two capillaries beds form the nephron portal system?
the glomerulus and the peritubular capillaries
What is the name of the second capillary bed in juxtamedullary nephrons?
the vasa recta
How much of the renal filtrate is absorbed back into the blood?
99%
What are the two functioning parts of the countercurrent multiplier system?
TAL- allows for Na+ effluex into interstitium
DTL- allows for H2O to enter interstitial fluid
What is the purpose of the vasa recta in the countercurrent exchange system?
To move Na+ from the TAL to the DTL interstitium, and H2O from the DTL interstitium to the TAL
What is the ultimate effect of the RAAS system?
An increase in BP
During what weeks does the Embryonic stage of pulmonary development take place?
Weeks 4-7
What main events occur during the Embryonic stage of lung development?
Respiratory diverticulum -> tracheal growth -> esophagus and trachea separate -> lung buds form
What main pathologies originate from the Embryonic stage of lung development?
TEF and EA
During what weeks does the Pseudoglandular stage of pulmonary development take place?
Weeks 6-17
What main events occur during the Pseudoglandular stage of lung develoment?
terminal bronchioles and capillary network forms -> inactive alveoli begin to form
What main pathologies occur during the Pseudoglandular stage of lung development?
Potter’s sequence as well as diaphragmatic hernia
During what weeks does the Canicular stage of pulmonary development take place?
Weeks 17-26
What main events occur during the Canicular stage of lung development?
Respiratory bronchioles and alveolar ducts form, T1 and T2 pneumocytes appear
During what weeks does the Saccular stage of pulmonary development take place?
Weeks 24-36
What main events occur during the Saccular stage of lung development?
Surfactant production begins, and the blood/air barrier forms completely
What main pathologies occur during the Saccular stage of lung development?
Respiratory Distress Syndrome
During what weeks does the Alveolar stage of pulmonary development take place?
32 weeks to 8 years
How does retinoic acid (Vitamin A) affect lung development?
Key for lung bud initiation Insufficient retinoic acid can lead to lung defects or pulmonary aplasia
Branching morphogenesis of the lungs is dependent on what growth factor?
FGF
Around what period does the pronephros first appear?
4 weeks
What vitamin is pronephros formation dependent on?
Vitamin A
For what period is the mesonephros present?
Weeks 5-16
What induces the mesonephros to develop?
the mesonephric duct
What critical structure appears during the mesonephros period?
the ureteric bud
The Metanephros begins development at what week? Around what week does it finish?
Week 5; Week 10
What are the two functional parts of the Metanephros?
the metanephric blastema and the ureteric bud
What part of the nephron is formed by the metanephric blastema?
Bowman’s capsule through the DCT
What part of the nephron is formed by fetal capillaries?
the glomerulus
What part of the nephron is formed by the ureteric bud?
CT through the ureter (minor/major calyces and renal pelvis)
What structure induces the ureteric bud to elongate and begin branching morphogenesis?
the metanephric blastema
What is the function of Wilms Tumor 1 gene in nephrogenesis?
WT1 is required for maintenance of the blastema
What is the function of retinoic acid in nephrogenesis?
ureteric bud formation
What is the function of FGF in nephrogenesis?
stimulation of bud growth and branching
Around what period do the kidneys relocate from a sacral to lumbar position?
6-9 weeks
What is the main pathology of congenital hydronephrosis?
blockage of the ureter
In a patient with an ectopic ureter where might dribbling of urine be found?
the vagina, rectum, etc.
What is the net transaction of the phosphate buffer system in the nephron?
1 H+ secreted into tubular lumen for 1 HCO3 added into bloodstream
What does an elevated ion gap mean?
That there are additional organic acids in the bloodstream acting to lower the pH
The acronym MUDPILES is used to represent potential causes of elevated ion gap metabolic acidosis. What does it stand for?
Methanol, Uremia, Diabetic ketoacidosis, Paraldehyde or Paracetamol or Propylene glycol, Iron tablets, Lactic acidosis, Ethylene glycol, Salicylates or Starvation ketoacidosis
What are the potential causes of a normal anion gap metabolic acidosis (HARDASS)?
Hyperalimentation (tube feeds), Addison’s disease, Renal tubular acidosis, Diarrhea, Acetazolamide, Spironolactone, Saline infusion
What are causes of acute/chonic respiratory acidosis?
Acute- airway obstruction, CNS depression to due drug overdose, pneumonia, pulmonary edema
Chronic- COPD, emphysema, CNS depression, NM impairment (ALS)
What are causes of metabolic alkalosis?
Vomiting, diuretics, exogenous HCO3, excessive aldosterone
What can cause respiratory alkalosis?
Acute- hyperventilation, salicylate intoxication or sepsis
Chronic- pregnancy, cirrhosis
How could you calculate anion gap from lab results?
Na+ + HCO3 - Cl-
When is an anion gap elevated?
When it is greater than 14
