Respiratory (exam 3) Flashcards
Why are bronchioles important?
Wrapped in smooth muscle
Expand and contract
Control airflow into and out of alveoli
What is the primary reactive airway?
Bronchioles
Where does gas exchange take place?
Alveolus
What makes up the upper respiratory tract?
Larynx and above
Nasal cavity, pharynx, larynx
What makes up the lower respiratory tract?
Trachea and below
Trachea, primary bronchi, lungs
Where does the division between the upper and lower respiratory tracts start?
Trachea
What is the respiratory mucosa?
Mucous membrane lines respiratory tract
Traps pathogens, dust, etc
Immune support (T & B cells, macros)
Lubricant
What are the mucous membranes?
Epithelial membranes that line body surfaces opening directly to the exterior
What are the functions of mucosa?
Protection (underlying tissue)
Immune Support (capture debris, mucins presence)
Lubricant (allow food to move to digestive tract)
What is the purpose of the pleura?
Sac around the lungs
What is the purpose of the nasal cavity? Turbinates?
Turbinates are formed by the conchi
Warm, filter, humidify air
What is the purpose of the pharynx?
Shared by respiratory and digestive tracts
3 regions: nasopharynx, oropharynx, laryngopharynx
What is the purpose of the larynx?
Tighter the strings= higher pitch
Looser the strings= lower pitch
Thyroid cartilage makes the adams apple
What is the purpose of the trachea?
Windpipe
Wrapped with cartilage to keep it open
C rings because esophagus is behind= allows food passage
What is the purpose of the bronchi?
2: right and left
Right is wider and straighter= aspirations typically caught here
What is the purpose of the alveoli?
Gas exchange
Functional unit of the respiratory system
Clustered to give more surface area
kept open by surfactant= decrease surface tension, keep alveoli from sticking together
What part of the respiratory system does emphysema destroy?
Destroys the alveoli
How many lobes does the right lung have? Left lung?
Right= 3 Left= 2, no middle due to heart
What is the serous membrane? Where in the body are they?
2 layers with serious fluid in between (parietal layer- hug cavity, visceral layer- hug organ)
Pericardium: around heart
Pleura: around lungs
Peritoneum: around viscera
How do we represent the pressure in the alveoli?
Pa
How do we represent the pressure outside the body? Does the pressure change?
Barometric pressure
Pb
Pressure doesn’t change
How do we represent the intrapleura pressure?
Pip
Which pressure involved in the respiratory tract never changes in a healthy individual?
Pip
What is pressure gradient in reference to the lungs?
Air moves from high to low pressures
What are the pressure gradients during inspiration (inhalation)?
Pb > Pa
Pip < Pa
What are the pressure gradients during expiration (exhalation)
Pa > Pb
Pip < Pa
What does it mean when Pa = Pip? Pb = Pip?
Collapsed lung
What is the primary muscle of inspiration? Secondary muscle?
Primary= diaphragm Secondary= External intercostals
Are muscles involved in normal expiration?
No
What are the primary and secondary muscles of forced expiration?
Primary= rectus abdominus Secondary= internal intercostals
What are the mechanics of breathing?
- Alveolar Surface Tension (surfactant)
- Elastic properties of the lung and chest wall (elastic recoil, compliance)
- Airway resistance
- Work of breathing
What kind of alveolar surface tension do we want? Do we want to increase or decrease it?
Decreased tension, keep open
Accomplished by surfactant
What part of breathing does elastic recoil affect?
Expiration
What part of breathing does compliance affect?
Inspiration
Stretch and expand
Do we want to increase or decrease airway resistance?
Decrease airway resistance
Airway resistance is bad, blockage, inhibits airflow
Discuss how the mechanics of breathing affect the work of breathing?
Decrease surface tension and increase elastic properties and decrease the work of breathing
Increase surface tension and decrease elastic properties and increase the work of breathing
What are the 4 steps of breathing?
Ventilation of lungs
Diffusion of oxygen from alveoli into capillary blood
Perfusion of systematic capillaries with oxygenated blood
Diffusion of oxygen from systematic capillaries into the cells
How does diffusion of CO2 occur?
Diffusion of CO2 from cells into systemic capillaries
Perfusion of systemic capillaries with CO2 blood
Diffusion of CO2 from capillaries into lungs
Exhalation of CO2
What role does the medulla play in respiration?
Normal rhythmicity center
What role does the apneustic center of the pons play in respiration?
Stimulates neurons to promote inspiration via external intercostals and the diaphragm
No air so says to inhale
What role does the pneumotaxic center of the pons play in respiration?
Stimulated neurons to promote expiration via the internal intercostals and the rectus abdominus
Need to move air out, causes expiration
What role does the pons play in respiration?
Adjustment of breathing
What role do chemoreceptors play in respiration?
Measure chemical (CO2 and O2) levels
Where are the central chemoreceptors located? What do they do?
Medulla
Detect increased levels in CO2 and then stimulate increase in respiration rate
Where are the peripheral chemoreceptors located? What do they do?
Aorta and Carotid bodies
Detect increased levels in CO2 and then stimulate increase in respiration rate
What are the functions of the pulmonary system?
Ventilate the alveoli
Diffuse gases into and out of the blood
Perfuse the lungs so the body receives oxygen
What is the minute volume?
Volume of air being moved in a minute
Ventilatory rate multiplied by the volume of air per breath
What is Alveolar ventilation?
How much air is actually getting to the alveoli for gas exchange
What are the Type 1 Alveolar cells (type 1 numocytes)? What do they do?
Epithelial cells of the alveoli
Where diffusion of respiratory gases occurs
What are the Type 2 Alveolar cells (type 2 numocytes)? What do they do?
Epithelial cells of the alveoli
Surfactant production
What are dust cells?
Macrophages in the alveoli
Does pulmonary circulation have a higher or lower pressure than the systemic circulation?
Lower pressure
How many pulmonary vessels are filled with blood at any given time?
One third of pulmonary vessels
Where does the pulmonary artery divide and enter the lungs?
At the Hilus
Do bronchus and bronchioles have accompanying arteries?
Yes each bronchus and bronchiole has an accompanying artery or arteriole
What is the alveocapillary membrane?
Formed by the shared alveolar and capillary walls
Gas exchange occurs across the membrane
Formed by type 1 numocytes
What direction does gas move in reference to concentration gradient?
Moves down the concentration gradient
What is the Ventilation- Perfusion Ratio?
V-Q Ratio
Airflow to blood flow
Match airflow to blood flow to alveoli
How is oxygen transported?
Dissolved in plasma
Oxyhemoglobin- 1 hemoglobin has 4 hemes each with an iron, oxygen binds to the iron, gives off red glow
How is carbon dioxide transported?
Dissolved in plasma
Bicarbonate (HCO3)- most carried here
Carbaminohemoglobin- CO2 bound to hemoglobin
What is hypoxic pulmonary vasoconstriction?
Caused by low alveolar PO2
Blood is shunted to other, well ventilated portions of the lungs
What is acidemia?
Acidic blood
Causes pulmonary artery constriction
High CO2 in blood
What is dyspnea?
Shortness of breath (SOB)
What is orthopnea?
Dyspnea (SOB) when laying down
What is Paroxysmal nocturnal dyspnea (PND)?
Causes orthopnea
People with CHF
Generally with Liver failure
What is tachypnea?
Hyperpnea
Fast breathing rates
What is bradypnea?
Slow respiratory rate
What is apnea?
No breath
What is Kussmaul respirations?
Hyperpnea
Fast breathing when we have acidic blood (high CO2 in blood)
What is Cheyne- Stokes respirations?
End of life respirations
Periods of apnea then hyperpnea
What does Hypoventilation cause?
Hypercapnia (high CO2 levels)
What does Hyperventilation cause?
Hypocapnia (low CO2 levels)
What is Hemoptysis?
Blood in sputum
What is cyanosis?
Bluing Short term (acute) hypoxia
What is clubbing?
Chronic, longer term hypoxia
Shortening of nails/ nails beds
What is hypoxemia?
Low oxygen in the blood
What is the difference between hypoxemia and hypoxia?
Hypoxemia is low oxygen in blood
Hypoxia is low oxygen in general tissues
What are the acute and late chronic symptoms of hypoxia?
Early RAT is late to BED
Restlessness, Anxiety, Tachycardia/ Tachypnea & cyanosis
Bradycardia, Extreme restlessness, dyspnea (severe), clubbing
What are the symptomes of hypoxia in pediatrics?
F- Feeding difficulty I- Inspiratory stridor N- Nares flare E- Expiratory grunting S- Sternal retractions
What is pulmonary edema?
Excess water in the lungs
What leads to pulmonary edema?
Valvular dysfunction, coronary artery disease, left ventricular dysfunction
Injury to capillary endothelium
Blockage of lymphatic vessels
What is aspiration?
Passage of fluid and solid particles into the lungs
Most often on the right side
What is atelectasis? What types are there?
Partial lung collapse
Compression atelectasis
Absorption atelectasis
What is compression atelectasis?
Something growing (tumor or fungal growth), stop airflow, cause collapse Does not break pleura
What is absorption atelectasis?
Mucous plug or something in an alveoli, decrease flow, cause collapse, bad ventilation, shunting to better ventilated alveoli
Does not break pleura
What is bronchiolitis? Who is it most common in? When do adults get it?
Inflammatory obstruction of the bronchioles (small airways)
Most common in children
Occurs in adults with chronic bronchitis, in association with a viral infection or with inhalation of toxic gases
What is bronchiolitis obliterans?
Exaggerated bronchiolitis, persists for long time, obliterates bronchiole tissue
What is a pneumothorax?
True collapsed lung
What is an open pneumothorax?
Open to external environment
Pip = Pb
What is a tension pneumothorax?
Microscopic tear of pleura (Pa & Pip) causes a one-way valve
Every inhalation collapses the lung more adding air to intrapleural space
Pip = Pa
See tracheal deviation moving toward the good lung
What is a spontaneous pneumothorax?
Spontaneous
Tall, white, young, men that like to drink and smoke
What is a secondary pneumothorax?
Due to injury, trauma or disease
More pathologic
What is pleural effusion?
Collection of stuff or junk in intrapleural space
What is transudative effusion?
Clear fluid in the intrapleural space
What is exudative effusion?
Thick, junky, non clear fluid in intrapleural space
What is hemothorax?
Blood in intrapleural space
Usually from trauma
What is empyema?
Gross, pussy, fluid in intrapleural space
Infection
What is chylothorax?
Lymph fluid in intrapleural space
Trauma or post surgery
What is flail chest?
Instability of a portion of the chest wall
Inhale draws lung into thoracic cavity (decrease thoracic pressure)
Exhale drives lung outward (increasing thoracic pressure)
Trauma, congenital defect
What is pneumoconiosis?
Inhalation of toxic substances (silica, asbestos, coal, exposure to toxic gases)
What is allergic alveolitis?
Hypersensitivity pneumonitis
What is Acute Respiratory Distress Syndrome (ARDS)?
Respiratory failure characterized by acute lung inflammation
Not carrying out adequate gas exchange
Cause= chronic lung inflammation
Injury to the pulmonary capillary endothelium (inflammation and platelet activation)
Surfactant inactivation
Atelectasis
Treat with ventilator of oxygen
What is obstructive pulmonary disease? Symptoms? Common obstructive disorders?
Airway obstruction that is worse with expiration
Dyspnea (SOB), wheezing
Asthma, Emphysema, Chronic bronchitis
What is status asthmaticus?
Asthma attack
What is chronic bronchitis?
Hypersecretion of mucus and chronic productive cough that lasts at least 3 months of the year for at least 2 consecutive years
Persistent inflammation after infection is gone
Harder to get air out
What are chronic bronchitis symptoms?
“Blue Bloater”
Hypoxia- cyanosis (blue)
Hypercapnia (Increase CO2)
What is emphysema?
Loss of elastic recoil
Harder time pushing extra air out
Destroy alveoli bubbles
Lose surface area
What are emphysema symptoms?
“Pink Puffer”
Increase CO2 retention (pink)- can’t breathe it out
Purse lip breathing
Barrel chest
What is pneumonia? What types are there?
Infection lead to inflammation causing fluid build up Inflammation of lung (alveoli) Community acquired pneumonia Hospital acquired pneumonia Pneumococcal pneumonia Viral pneumonia
What are chest infiltrates? What are they a clinical indicator of?
Increase inflammation and fluid, get a bright white patch on the x-ray
Indicatory of pneumococcal pneumonia
What is Tuberculosis?
Mycobacterium tuberculosis Airborne transmission Lives in macros (dust cells) and evades immune system Induces phagocytosis Necrosis- destroy lung tissue
What is acute bronchitis?
Acute infection or inflammation of the upper airways (bronci)
Commonly follow a viral illness
What is a pulmonary embolism?
Blockage of blood flow due to occlusion to the lungs
Commonly arise from thrombi of deep veins in the thigh
What is pulmonary hypertension?
High blood pressure in pulmonary artery
Pulmonary artery carries deoxygenated blood
What are the classifications of pulmonary hypertension?
Pulmonary arterial hypertension
Pulmonary venous hypertension (CHF)
Pulmonary hypertension due to respiratory disease or hypoxemia (COPD)
Pulmonary hypertension due to thrombotic or embolic disease (PE)
Pulmonary hypertension due to disease of the pulmonary vasculature
What is cor pulmonale?
Right heart failure
Primarily due to right ventricular enlargement (failure)
What is the most common cause of lung cancer?
Cigarette smoking
