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Block 4 > Week 5 > Flashcards

Week 5 Flashcards

1
Q

What does partial pressure of a gas mean?

A

* The pressure exerted by a single gas in a mixture

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2
Q

Define

  1. FIO2
  2. PIO2
  3. PA
  4. PAO2
  5. Pa
  6. PaO2
  7. PACO2
  8. PaCO2
  9. PECO2
  10. PB
A
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3
Q

Define

  1. PV
  2. PPL
  3. PAW
  4. PTP
  5. RAW
  6. R
  7. VT
  8. VD
  9. VA
  10. VE
  11. n
A
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4
Q

During exercise what happens to

  1. Cardiac output
  2. Arterial pressure
  3. Skeletal muscle arteries
  4. Sympathetic activity
  5. Tidal volume
  6. Breathing frequency
  7. Oxygen demand
  8. Production of CO2
A
  1. Increased cardiac output
  2. increased
  3. dilated skeletal muscle arteries - to allow for max blood flow to muscles
  4. increased sympathetic activity
  5. increased tidal volume
  6. increased breathing frequency
  7. increased oxygen demand
  8. increased production of CO2
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5
Q

with more external power output (more exercise) there is (BLANK) oxygen consumption?

A
  1. more oxygen consumption
    * at a certain exercise intensity oxygen consumption levels out and there is a change to anaerobic metabolism
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6
Q

How does oxygen consumption change between trained and untrained individuals?

A
  1. Trained individuals have higher oxygen consumption with exercise before moving onto anaerobic metabolism
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7
Q
  1. What is VO2 max?
  2. What is the equation for this?
A
  1. maximum oxygen consumption.
  2. VO2 = CO X rate of oxygen consumption of muscles
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8
Q

With VO2 equation → what are ways to increase VO2

A
  1. Increase SV (part of cardiac output) → no increase in HR because this is just due to age
    * CO increases with training (via SV)
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9
Q

Why do trained athletes have bradycardia at rest?

A
  • trained athletes have increased SV
  • If athletes maintained “normal” HR then their cardiac output would be too large due to large SV
  • To have normal cardiac output at rest → reduced HR paired with increased SV normalizes CO
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10
Q

How is Stroke volume increased? (2)

A
  1. Increased CVP which leads to increase in preload and therefore end diastolic volume
  2. Increase in ventricular chamber size
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11
Q

What is sports anemia?

A
  1. athletes have increased plasma albumin production which leads to more fluid/plasma volume
  2. This means concentration of hemoglobin falls → this is anemia (low hematocrit)
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12
Q

What leads to muscle’s increased O2 extraction?

A
  1. Increased capillary formation throughout muscles;; increased muscle blood flow and decreased diffusion distance for oxygen
  2. increased expression of mitochondrial enzymes → leads to greater consumption of O2
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13
Q
  1. What is static exercise?
  2. what type of hypertrophy does this leads to?
A
  1. exercise done for a short duration in one spot. Usually using weights.
  2. concentric hypertrophy
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14
Q
  1. What is dynamic exercise?
  2. what type of hypertrophy does this leads to?
A
  1. repetitive and sustained movement of limbs like running or bicycling
  2. Eccentric hypertrophy
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15
Q
  1. What is internal respiration?
  2. What is external respiration?
A
  1. When mitochondria use oxygen to make energy and CO2 within the cell
  2. What the lungs do → deliver continuous amount of oxygen to tissues
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16
Q

What 3 processes are involved in external respiration?

A
  1. Ventilation - bulk flow of gas from atmosphere into the lungs
  2. Perfusion - circulatory system job to deliver oxygen to tissues and pick up CO2 to bring back to lungs
  3. Diffusion (molecular level) - diffusion occurring across membrane at the blood gas interface in lung where O2 diffuses in and CO2 diffuses out
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17
Q

What is the partial pressure of oxygen in…

  1. atmosphere
  2. airway/bronchi (inspired air)
  3. Alveoli
  4. Systemic arterial blood
  5. Pulmonary arterial blood
A
  1. 159 mmHg
  2. 149 mmHg
  3. 100 mmHg
  4. 97 mmHg
  5. 40 mmHg
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18
Q

What is the partial pressure of CO2 in…

  1. atmosphere
  2. Alveoli
  3. Systemic arterial blood
  4. Pulmonary arterial blood
A
  1. 0 mmHg
  2. 40 mmHg
  3. 40 mmHg
  4. 46 mmHg
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19
Q

one equation for partial pressure

A

Px= total pressure X fractional concentration of X

fractional concentration is a percentage of whole gas mixture

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20
Q

What is oxygen’s composition (fractional concentration) in dry air?

A

21% (159 mmHg)

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21
Q

Why is oxygen partial pressure in upper airway different/lower than atmosphere?

A
  1. there is humidity in airway that lowers the partial pressure of oxygen to 149 mmHg (instead of 159 mmHg in atmosphere)
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22
Q

What is the main pushing force that moves oxygen from lungs to circulation

  1. pressure gradient of gas
  2. hemoglobin
A
  1. oxygen movement via only partial pressure doesn’t get much oxygen into circulation
  2. ***greater effect**** Hemoglobin has high affinity for oxygen so oxygen moves into hemoglobin and allows there to be continued movement of oxygen from lungs to circulation via pressure changes
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23
Q

What muscles are involved in inspiration? (3)

A
  1. Diaphragm - flattens and pulls lungs out increasing chest wall cavity
  2. External intercostals - raise the ribs in bucket handle motion (water moves upward and outwards leading to chest cavity expansion)
  3. Accessory muscles - scalene and sternocleidomastoid (help with breathing in distress)
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24
Q

What muscles are involved in expiration when breathing?

A
  1. only requires relaxation of 3 inspiratory muscles discussed in other card.
  • lungs need to be elastic - tendency to shrink back
  • contraction of the abdominals can help assist pushing diaphragm up
  • Internal intercostals can help pull ribs downward and inward (during heavy breathing)
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25
Q

What creates negative pressure in intrapleural space?

A

On inspiration lungs try to move inwards (due to its elastic characteristics) while chest cavity moves outwards → two opposite pressures leads to creation of negative pressures

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26
Q

What is functional residual capacity?

A

The volume remaining in the lungs after a normal, passive exhalation

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27
Q

Why is there no negative pressure in pneumothorax?

A

air enters the pleural space which leads to no negative pressure.

  • The lungs, due to their elasticity, collapse and even with chest wall expansion - negative pressure is still lost
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28
Q

What is TLC (total lung capacity)?

A

maximum amount of air your lungs can hold

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29
Q

What is RV (residual volume)?

A

The amount of air remaining in the lungs after a maximal expiration

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30
Q

Explain the compliance curve for lungs, chest wall, and respiratory system

A
  • The purple line is compliance of chest wall - It crosses to left of y axis because chest wall creates negative pressure in thoracic cavity
  • The black line is compliance of lungs - since lungs have elasticity component they only have positive pressure and only lands on right of Y axis
  • The blue line is combination of lungs and chest wall
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31
Q

Explain how alveolar pressure can be negative and positive at different points of breathing?

A
  1. during inspiration the alveolar space increases and causes negative pressure to bring in inspired air into lungs
  2. during expiration there is decrease in alveolar volume and an increase in alveolar pressure which pushes air out of lungs
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32
Q
  1. What is lung compliance?
  2. What is its relationship with elasticity of lungs?
A
  1. the measure of stiffness of lung that reflects the extent of elastic recoil → it is a measure of lung expandability
  2. The more compliant the lungs are the easier it is to inflate but less elastic. -losing elastic recoil
  3. Less compliance the lungs are harder to inflate but more elastic recoil
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33
Q

In lung volume over pressure graph → how do you determine compliance?

A

Slope is compliance

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34
Q

What 3 factors control compliance?

A
  1. Elastic tissue - more elastic tissue decreases compliance
  2. Surface tension - this reduces lung compliance. With more surface tension there is atelectasis (alveolar collapse) → typically surfactant reduces surface tension
  3. Ease of rib movement - with less rib movement there is less compliance (not easy to fill lungs)
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35
Q

What changes to total lung capacity, functional residual capacity, and residual volume occur in emphysema?

A
  1. emphysema leads to increased compliance
  2. TLC increases because lungs can fill more easily
  3. FRC is increased because elasticity is decreased - difficult to exhale
  4. RV is increased because elasticity is decreased - difficult to exhale
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36
Q

What changes to total lung capacity, functional residual capacity, and residual volume occur in fibrosis?

A
  1. Fibrosis leads to decrease in compliance - so lungs can’t fill easily
  2. Low TLC - can’t fill up lungs completely
  3. FRC and RV are low as well because increased elasticity leads to more exhalation of air, leaving little air left in lungs.

remember compliance and elasticity are opposite

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37
Q

What is the function of type II alveolar cells?

A
  1. produces surfactant in the lungs which reduces surface tension in the alveolar lining
  2. Surfactant increases alveolar stability
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38
Q
  1. What is considered part of upper respiratory tract?
  2. What is the function of this part?
A
  1. Everything from nostrils to the trachea
  2. conditions air coming in, humidifies air coming in, captures particles/pathogens
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39
Q
  1. What is considered part of lower respiratory tract?
  2. What is the function of this part?
A
  1. From trachea to alveoli
  2. site of gas exchange
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40
Q

What is the function of goblet cells?

A

secretes mucus which sits above epithelia

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41
Q

What is the function of ciliated epithelial cells in respiratory system?

A
  • ciliated cells beat upwards and push mucus upwards so it can be readily expelled out of lungs (most of the time we swallow mucus)
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42
Q
  1. What is the function of alveolar macrophages?
  2. What are some consequences of hyperactive macrophages?
A
  • Scavenge inside of alveoli and pick up any particles or debris that make it down to alveoli. → Most abundant in smokers
  • hyperactive macrophages can contribute to emphysema (degradation of elastin)
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43
Q

What are the steps to typical acute inflammatory response following bacterial infection of an alveolus?

A
  1. Stimulated macrophages release cytokines and chemokines
  2. Lead to vasodilation and vascular leakage which can lead to edema
  3. There is thickening of hyaline membrane for alveolus
  4. Chemokines attract neutrophils to come into alveoli
  5. Neutrophils ingest bacteria and produce ROS and proteases which can damage lung but overall meant to get rid of pathogen

in chronic cases - you get deposition of fibrin and collaged which compromises elasticity of lungs (lung fibrosis)

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44
Q

What is Waldeyer’s ring? (lymphatic system)

A
  • a ring of lymphatic structures in the back of the throat
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45
Q

Differentiate between deep and superficial lymphatic branches?

A
  1. Deep lymphatic branches - drains lymph from lung parenchyma (where gas exchange occurs) ; usually around alveoli
  2. Superficial lymphatic branches - drains lymph from exterior surfaces of lungs and pleural membranes
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46
Q

What is the function of dendritic cells in interstitial tissue of lungs?

A
  1. they sample antigens and when activated migrate to lymphatics to activate T cells and B cells
  2. B cells produces IgA antibodies and are committed to these antibodies (B cells become fully differentiated and make IgA right beneath surface of epithelial layer)
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47
Q

What is the role of IgA in mucosal immune defense?

A
  1. Secreted IgA on the gut surface can bind and neutralize pathogens and toxins
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48
Q
  1. What is the Henderson-Hasselbach equation?
A
  1. way of determining the pH of a buffer
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49
Q

What is the modulated H-H equation for biological purposes in circulation and lungs?

A
  • pH= 6.1 + Log ([HCO3-]/ (0.03 * [pCO2]))
    • The HCO3- part is regulated by kidneys
    • The pCO2 part is regulated by lungs
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50
Q

What is the bicarbonate equation?

A
  • CO2 + H2O H2CO3 H+ + HCO3-
  • Bicarbonate is HCO3-
  • Carbonic acid is H2CO3
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51
Q

If there is too much CO2 or H+ how is this regulated in the body?

A
  • If there is too much CO2 then it gets blown out by lungs
  • If there is too much H+ then it gets excreted by kidneys
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52
Q
  1. What does metabolic acidosis?
  2. What is compensation mechanism for this?
A
  1. Decreased pH due to decreased bicarbonate (HCO3-) → with less HCO3- the bicarbonate eqn moves more the right increases [H+] concn → decreased pH
  2. Compensated by lungs blowing of CO2 to raise pH (moves bicarbonate eqn to left, reducing H and increasing pH)
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53
Q
  1. What does respiratory acidosis?
  2. What is compensation mechanism for this?
A
  1. Decreased pH due to increased CO2 (moves bicarbonate eqn to right, increasing [H+], decreasing pH)
  2. compensated by kidney retaining HCO3- (bicarbonate) (moves bicarbonate eqn to left to decrease [H+] and increase pH)
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54
Q
  1. What does metabolic alkalosis?
  2. What is compensation mechanism for this?
A
  1. Increased pH due to increased bicarbonate
  2. Compensated by lungs retaining retaining CO2 (moves equation to right which increases concn of H+ → this decreases pH)
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55
Q
  1. What does respiratory alkalosis?
  2. What is compensation mechanism for this?
A
  1. Increased pH due to decreased CO2
  2. Compensated by kidneys excreting increased HCO3- (leads bicarbonate eqn to move to the right [increasing H+ concn]) meant to decrease pH
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56
Q

What is the anion gap equation?

A

Na – (Cl + HCO3-) = anion gap

  • the difference in concn between cations and anions
  • does not take into considerations all cations and anions just the main ones with highest concentration
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57
Q
  1. What does high anion gap mean?
  2. In what situations is anion gap increase seen?
A
  • This means there are unmeasured anions that were added to the system.
  • When there is increase in more organic acids like lactate and ketoacids. This is because when acids are introduced they donate H+ to bicarbonate.
  • Now you have neg charge from acid and positive charge from Na+ (still neutral) -but- when checking cation/anion levels you have decrease in HCO3- and so anion gap increases
  • anion from lactate or ketoacids don’t get counted
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58
Q

What is your pharynx and what is it composed of?

A
  1. basically your throat
  2. nasopharynx (increase resonance for speech, contains auditory tubes, contains pharyngeal tonsil)
  3. soft palate/uvula
  4. osopharynx (contains palatine, linguil tonsils, and epiglottis
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59
Q

What is the larynx?

A
  • The voice box formed by cartilage
  • vocal cords are dense connective tissues covered in stratified squamous epithelium (not respiratory epithelium)
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60
Q

What is phonation vs articulation?

A
  1. phonation - vibration produces sound
  2. Articulation - lips and tongues modify sounds for speech
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61
Q

Describe respiratory epithelium and its basement membrane?

A
  1. pseudostratified epithelium with thick basement membrane
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62
Q

Which ones are the ciliated cells, goblet cells, DNES (diffuse neuroendocrine cells), and basal cells in this image

A
  1. Arrow is ciliated cells that move mucus upwards
  2. Arrowhead is goblet cells - secrete mucus
  3. Triangle is basal cells - stem cells meant to replenish various cell types
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63
Q

List the subdivisions that come off the trachea

A
  1. trachea
  2. left or right main bronchus
  3. secondary bronchi
  4. tertiary bronchi (or segmental bronchi)
  5. Bronchioles
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64
Q

In histology of trachea - what parts can be identified (3) and what is found within each part?

A
  1. Epithelium - pseudostratified epithelium with thick basement membrane + mucosa is found here
  2. Lamina Propria (LP) - connective tissue fibers and lymphoid cells
  3. Submucosa (SM) - elastic fibers, seromucus glands, blood vessels, nerves, lymphatics
65
Q

In histology of bronchi - what does the walls contain? (5)

A
  1. respiratory epithelium → as there is more branching the cells in epithelium become shorter
  2. Plates of hyaline cartilage (arrows)
  3. bands of smooth muscle (arrow heads)
  4. seromucous glands (triangle) - as bronchus become smaller you see less and less goblet cells
  5. Lymphoid aggregates (A collection of B cells, T cells, and supporting cells)
66
Q

In histology of bronchiole - what does the walls contain? (3)

A
  1. smooth muscle is present
  2. epithelium shrinks and becomes cuboidal
  3. Goblet cells only seen in largest bronchioles
67
Q

What are club cells and where are they found

A
  1. found in smaller airways like terminal bronchioles, respiratory bronchioles, alveolar ducts
  2. function is to secrete surfactant, detoxify airborne chemicals via P450 enzymes, secrete lysozyme and antimicrobial agents
68
Q

Describe and identify terminal bronchioles vs respiratory bronchioles?

describe - meaning what is found in each

A
  1. Terminal bronchioles (star) have cuboidal epithelium and some smooth muscle → don’t have gas exchange
  2. Respiratory bronchioles (diamonds) - start of respiratory portion and do show gas exchange. Have Club cells, some alveoli, and little muscle
69
Q
  1. What is alveolar ducts continuous with?
  2. Do they have smooth muscle?
A
  1. continuous with respiratory bronchioles
  2. Extremely small amounts of smooth muscle
70
Q
  1. What are alveoli walls composed?
  2. What envelopes alveoli?
A
  1. pneumocyte cells
  2. anastomosing capillary network
71
Q

what are alveolar pores of kohn?

A

Spaces that link adjacent alveoli together- equalize air pressure between alveoli and allow air flow to alveoli that are blocked

72
Q

Differentiate between type I and type II pneumocytes

A
  1. type 1 - extremely flat cells. Form most of alveolar wall and create tight junctions between cells. closely assoc. with capillaries and cannot divide if damaged
  2. Type II - cuboidal cells that project into lumen. they produce surfactant and can differentiate into type I cells.
73
Q

What are the three layers of blood gas barrier?

A
  1. Surfactant and type I pneumocyte cytoplasm (arrow)
  2. Fused basement membrane (arrow head)
  3. Capillary endothelial cell cytoplasm (triangle)
74
Q

What is total ventilation?

A

a measurement of the amount of air that enters the lungs per minute

75
Q

what is the equation for total ventilation?

A

tidal volume X respiration rate

76
Q

What is the difference between total ventilation and alveolar ventilation?

A

total ventilation is total air that comes into lungs but alveolar ventilation is total air that reaches alveolus to do gas exchange

77
Q

What is normal PaCO2 ?

A

35-45

78
Q
  1. If PaCO2 is low what does this mean?
  2. What about if PaCO2 is high what does this mean?
A
  1. hyperventilation
  2. hypoventilation
79
Q

What is anatomic dead space?

A

areas in the respiratory tract that do not participate in gas exchange, such as nose and trachea

80
Q

What is alveolar dead space?

A

alveolar dead space refers to the alveoli that are ventilated but not perfused (blood circulation) and thus gas exchange does not take place.

81
Q

What is physiologic dead space?

A

equal to anatomic plus alveolar dead space

82
Q

What is normal physiological dead space VD/VT?

A

0.2-0.35 at rest

83
Q

What part of the lung is more compliant and expands more during inspiration? (thus more ventilated)

A
  • base is more compliant and expands more
84
Q

What is diffusion limited gasses?

A

Scenario in which the rate at which gas is transported away from functioning alveoli and into tissues is limited by diffusion rate of gas across membrane

85
Q

What is perfusion limited gas?

A

these gasses are limited by the rate of perfusion/blood flow in capillaries

86
Q

Why may increasing time of gas diffusion (0.25 seconds) be bad for the patient during exercise but not rest?

A
  • at rest they may be fine because there is an extra 0.5 second to diffuse oxygen into alveoli completely (since RBC spends 0.75 seconds in capillaries) but
    • During exercise they only have 0.25 seconds in capillaries and if time of gas diffusion increases more than this then oxygen levels can go down for individual
87
Q

pulmonary circulation is (BLANK A) flow, (BLANK B) pressure

A

Blank A - high flow

Blank B - low pressure

pulmonary circulation can accept a lot of blood and is very compliant

88
Q

Why is there little smooth muscle in pulmonary circulation?

A

Because all blood is going to alveoli and don’t need to control blood path with vessel constriction - less work from heart

pulmonary vascular resistance is approx. 1/10th of systemic vascular resistance

89
Q

What is perivascular cuffing?

A
  • With pulmonary edema - fluid moves into perivascular space which surrounds the artery and leads to compression of the artery
  • This causes engorgement of interstitial perivascular spaces (early edema) and increased arterial pressure
  • Late edema is fluid in alveoli
90
Q

How does body reduce pulmonary vascular resistance via capillaries?

A
  • Recruitment of more capillaries which means more total surface area → decrease resistance
  • Distention of capillaries allows them to hold more blood
91
Q

where is blood flow greater in lung? and why

Also, how does pulmonary arterial pressure and alveolar change throughout lung zones and its effects on arteries opening/closing

A
  1. blood flow is greater at base than at apex due to gravity
  2. at hilum the pulmonary arterial pressure is lowest and alveolar pressure is actually greater so arteries next to alveoli collapse
  3. At base of lungs the pulmonary arterial pressure is greatest/greater than alveolar pressure → so it opens arteries
92
Q

What is hypoxic pulmonary vasoconstriction and when is it beneficial?

A
  1. decreased alveolar PO2 leads to depolarization of K+ → then vasoconstriction
  2. this is beneficial when blood need to be redirected away from under ventilated areas or in fetus when lungs are not used
93
Q

What is the difference between arterial PO2 and arterial O2 content?

A
  1. Arterial O2 content is greater than PO2 because of hemoglobin
  2. The content is larger because O2 is attached to hemoglobin in circulation + what O2 is dissolved (which is smaller)
94
Q

What does the plateau at top of curve indicate?

A
  1. this means that even though there is a drop in lung PO2 (perhaps due to hypoventilation) Hb saturation can be maintained and will not drop a lot
  2. With severe hypoxia then you may see Hb saturation on steep side of curve
95
Q

In this hemoglobin dissociation curve…

-what does left shift mean?

what causes left shift when it comes to

  1. H+
  2. PCO2
  3. 2,3 BPG
A
  • left shift means Hb holds onto O2 more readily
  1. Increased pH or decreased H+ causes left shift
  2. Decreased PCO2
  3. Decreased 2,3 BPG
96
Q

In this hemoglobin dissociation curve…

-what does right shift mean?

what causes right shift when it comes to

  1. H+
  2. PCO2
  3. 2,3 BPG
A
  • right shift means Hb gives up O2 more readily
  1. low pH or high H+ causes right shift
  2. High CO2 (Bohr effect) causes right shift
  3. High 2,3 BPG causes right shift
97
Q

How does carbon monoxide change arterial O2 content vs arterial PO2?

A
  1. O2 content decreases
  2. arterial PO2 stays the same

this issue with CO is with binding to hemoglobin

98
Q

How does hyperbaric chamber help with carbon monoxide poisoning?

A
  • Hyperbaric chamber greatly increases PO2 in the alveoli
  • This increased dissolved O2 pressure decreases the half-life of CO-Hb and kicks off the CO from Hb due to increased O2 pressure
99
Q

What are the three ways CO2 is carried in blood? (which is most common)

this is in pulmonary circulation, not systemic circulation

A
  1. dissolved in blood
  2. carbamino compounds (second most common - accounts for 30 %)
  3. bicarbonate (most common - accounts for 60%)
100
Q

What is the Haldane Effect?

A

This is the opposite of Bohr effect meaning that Hb cannot carry as much CO2 because there is increased amount of O2.

  • this means blood cannot carry CO2 in form of bicarbonate and carbamino Hb since its too busy carrying increased O2 presence- this will increase PCO2
101
Q

Maturation of lungs

Embryonic Period

  1. what weeks of fetus growth?
  2. What happens in this stage?
A
  1. 1-7 weeks
  2. appearance of lung buds and main pulmonary arteries
102
Q

Maturation of lungs

Pseudoglandular Period

  1. what weeks of fetus growth?
  2. What happens in this stage?
A
  1. 5-16 weeks
  2. Formation of terminal bronchioles
103
Q

Maturation of lungs

Canalicular period

  1. what weeks of fetus growth?
  2. What happens in this stage?
A
  1. 16-26 weeks
  2. terminal bronchiole divides into two or more respiratory bronchioles → then divides into 3-6 alveolar ducts
104
Q

Maturation of lungs

Terminal Sac (Saccular) period

  1. what weeks of fetus growth?
  2. What happens in this stage?
A
  1. 26 wks to birth
  2. terminal sacs (primitive alveoli) form
105
Q

Maturation of lungs

Alveolar period

  1. what weeks of fetus growth?
  2. What happens in this stage?
A
  1. brith to childhood/adolescence
  2. maturation of alveoli
106
Q

What is a tracheoesophageal fistula?

A
  1. abnormal connection in one or more places between the esophagus and the trachea. These two should not connect.
107
Q

What is esophageal atresia?

A

a condition in which an abnormal gap forms between the baby’s esophagus and stomach. Instead of ending in the stomach, the esophagus ends in a pouch.

108
Q

what is polyhydramnios?

A

excessive accumulation of amniotic fluid which can happen with esophageal atresia because fetus cannot swallow amniotic fluid

109
Q

How does diaphragm develop during fetal development?

A
  1. fusion of pleuroperitoneal folds with septum transversum and mesentery of esophagus
110
Q

What is congenital diaphragmatic hernia?

A

When diaphragm fails to properly separate the abdomen from thorax and show it leads to intestines moving up into the thorax

  • can lead to hypoplasia of lungs - usually on left side
111
Q
  1. What is TTN (transient tachypnea of newborn)
  2. symptoms?
  3. how is treated
A
  1. Caused by impaired fetal lung fluid clearance. Normally in utero, the fetal airspaces and air sacs are fluid filled.
  2. tachypnea, labored breathing
  3. supportive care with supplemental oxygen or CPAP to maintain alveolar integrity
112
Q

How does fetus usually get rid of fluid in airspaces late in pregnancy or at birth?

A

chloride and fluid secreting channels in lung epithelium are reversed so fluid absorption occurs and fluid is removed

113
Q
  1. What are risk factors for TTN (transient tachypnea of newborn) (5)
A
  1. C-section
  2. Precipitous delivery
  3. Late preterm (34-36 weeks) or early term (37-38)
  4. Maternal sedation or medication
  5. Gestational diabetes
  6. and more
114
Q

What is normal pregnancy length?

A

40 weeks

115
Q
  1. What is Neonatal Pneumonia
  2. symptoms?
  3. how is treated
A
  1. respiratory infection in newborn that can be bacterial, viral, fungal, etc. Since there is underdevelopment of respiratory cilia and less macrophages the fetus cannot clear pathogens well.
  2. Tachypnea, suspicious appearing tracheal aspirates, cough, apnea, high or low temperature, poor feeding, abdominal distension, and lethargy
  3. with early onset give penicillin and aminoglycoside as initial treatment
116
Q

what are risk factors for neonatal pneumonia? (4)

A
  1. Maternal group B strep carrier
  2. PROM (prolonged rupture of membranes)
  3. Maternal fever
  4. Prematurity
  5. and more
117
Q
  1. What is RDS (respiratory distress syndrome)
  2. symptoms?
  3. how is treated
A
  1. Caused by insufficiency of alveolar surfactant → increased surface tension in alveoli resulting in collapse of alveoli and low lung volumes
  2. Tachypnea, nasal flaring, grunting, subcostal/intercosta/suprasternal retractions
  3. Administer surfactant and usually resolves within 3-4 days
118
Q

What are risk factors for RDS? (4)

A
  1. prematurity
  2. gestational diabetes
  3. male infant
  4. multiple gestation
119
Q
  1. What is MAS (meconium aspiration syndrome)
  2. how is treated
A
  1. When fetus passes meconium (first poop) before birth and are at risk or have aspirated meconium in utero or after birth. Meconium causes inflammation and epithelial injury → leads to partial obstruction
  2. focus on decreasing inflammation
120
Q

What are risk factors of MAS (meconium aspiration syndrome) (3)

A
  1. MSAF (meconium stained amniotic fluid)
  2. Postterm (more than 42 weeks)
  3. Fetal distress
121
Q

where does the costal part of diaphragm end?

A

Ends of ribs 11 and 12 (11 because right side of diaphragm is higher up due to liver being there)

122
Q

what is the motor supply/innervation to the diaphgram?

A

Phrenic nerve (C3,C4,C5)

123
Q

what is the sensory supply to the diaphragm?

A
  1. central part of diaphragm - phrenic nerve
  2. peripheral parts - intercostal nerves
124
Q

What is the main artery that gives off blood supply to diaphragm?

A

Inferior phrenic artery (right and left)

125
Q
  1. what are the three openings in the diapgram?
  2. And at what levels of spine are they at?
A
  1. Caval opening - T8
  2. Esophageal Hiatus - T10
  3. Aortic Hiatus - T12
126
Q

What goes through Caval opening of diaphgram?

A
  1. IVC (inferior vena cava)
  2. Right phrenic nerve
127
Q

What goes through esophageal hiatus opening of diaphgram?

A
  1. esophagus ***know**
  2. ant. and post. vagal trunks
  3. esophageal branch of left gastric vessels
  4. lymphatic vessels

just need to know #1 but rest is extra

128
Q

What goes through Aortic Hiatus opening of diaphgram?

A
  1. Descending aorta
  2. Thoracic duct
  3. Possibly azygous veins
129
Q

What two movements do intercostal muscles cause with their contraction?

A
  1. anteroposterior movement - pump handle movement
  2. lateral movement of thorax
130
Q

What is the parietal pleura vs visceral pleura?

A
  1. parietal - lines thoracic wall, diaphragm, and mediastinum
  2. Visceral pleura - firmly attached to outer surface of lungs
131
Q

what are the two pleural recesses?

A
  1. costodiaphragmatic recess
  2. costomediastinal recess
  • these are like gutters where parietal pleura oppose eachother
132
Q

Where do you listen to to hear…

  1. apex of right lung
  2. middle lobe of right lung
  3. superior lobe of right lung
  4. inferior lobe of right lung
  5. apex of left lung
  6. inferior lobe of left lung
  7. superior lobe of left lung
A

image

133
Q

where do the roots of the lungs align with vertebra?

A

level T5 to T7

134
Q
  1. what is the pulmonary ligament?
  2. Its purpose?
A
  1. fold of pleura that projects inferiorly from the root of the lung.
  2. It allows movement of lung root during respiration
135
Q

What does RALS mean in terms of anatomy of lungs?

A
  1. Right anterior left superior
  2. meaning on right lung the pulmonary artery is anterior to the bronchus
  3. on the left lung the pulmonary artery is superior to the bronchus
136
Q

Where do vagus and phrenic nerve land in relation to root of lungs?

A

image

137
Q

Describe the impressions found on RIGHT LUNG

A

image

138
Q

Describe the impressions on the LEFT LUNG

A

image

139
Q

in relation to spine vertebrae → where does trachea start and end?

A
  1. C6 to T4/T5 (sternal angle)
140
Q

What is the carina?

A

splits the main bronchi → creates main bronchi

141
Q

Which main bronchi is food/foreign object most likely to be stuck in?

A
  1. right main bronchus because it is wider and more vertical than left
142
Q

Which level of bronchial tree if first division that individually supplies a lobe of the lung?

A
  1. secondary bronchus (3 on right and 2 on left)
143
Q
  1. Is terminal bronchioles considered part of anatomic dead space?
  2. What about respiratory bronchioles?
A
  1. yes
  2. no
144
Q

How are bronchial arteries and veins positioned throughout the lungs?

A
  1. arteries follow along with the bronchus (segmental/tertiary bronchus)
  2. veins lie between and around the margins of the bronchopulmonary segments in the connecting tissue
145
Q

What do bronchial veins drain into?

A
  1. Bronchial veins drain into pulmonary veins (which then drain into left atrium) or azygous vein (which then drain into SVC)
146
Q
  1. Where does the lymph from lungs end up draining into?
  2. And which one receives more lymph/coverage of lungs
A
  1. Right: right lymphatic duct (D) ; Left: thoracic duct (E)
  2. The right lymphatic duct gets lymph from all of right lung and part of left lung
147
Q
  1. What is the superior part/beginning of posterior mediastinum?
  2. What is the inferior end?

in terms of vertebral level

A
  1. begins at sternal angle (T4/T5)
  2. T12
148
Q

What is found in posterior mediastinum?

A
  1. esophagus
  2. thoracic aorta and branches
  3. azygous venous system
  4. Thoracic duct and lymph nodes
  5. Thoracic sympathetic trunks and ganglion
  6. Vagus nerves
149
Q

Identify which is azygos, hemiazygos, and accessory hemiazygos vein

A

image

150
Q
  1. What is the cisterna chyli
  2. Where does it start (in relation to vertebral level)?
  3. What opening of diaphragm does it pass through?
A
  1. the origin of thoracic duct
  2. Begins at T12 and goes upwards
  3. aortic opening. Ascends on the right side of aorta
151
Q

The thoracic duct recieves lymph from all regions of the body except?

  1. blank a
  2. blank b
  3. and blank c (2 parts to c)
A
  1. right arm
  2. right thorax
  3. right head and neck
152
Q

How do you determine respiratory vs metabolic acidosis?

(pH, PCO2, HCO3-)

A

image

153
Q

What is normal pH range?

A

7.35-7.45

154
Q

What is normal HCO3- range?

A

22-28 mEq/L

155
Q

What is normal PCO2 range?

A
  1. 33-45 mmHg
156
Q

What is the expected compensation for

  1. respiratory acidosis
  2. metabolic acidosis
  3. respiratory alkalosis
  4. metabolic alkalosis
A

image

157
Q
  1. Decreased HCO3- or increased CO2 (Blank A) pH
  2. Increased HCO3- or Decreased CO2 (Blank B) pH
    3.
A
  1. Blank A = decreases
  2. Blank B = increases
158
Q

What is normal anion gap?

A

12 mEq/L

Block 4 (8 decks)

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