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414 Cards in this Set
- Front
- Back
Which six structures make up the conducting zone of the respiratory tree?
|
The nose, the pharynx, the trachea, the bronchi, the bronchioles, and the terminal bronchioles
|
|
True or False: One of the functions of the conducting zone of the lungs is to warm and humidify air.
|
true; the conducting zone also filters air
|
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What type of muscle is found in the walls of the conducting airways in the anatomic dead space?
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smooth muscle
|
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The area of the lungs that participates in gas exchange is also called the respiratory zone. What anatomic areas does it encompass?
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The respiratory bronchioles, the alveolar ducts, and the alveoli
|
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Cartilage is present only in what two components of the respiratory tree?
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Trachea and bronchi
|
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Which zone of the respiratory tree includes the anatomic dead space?
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The conducting zone
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Goblet cells extend to the _____ (respiratory/terminal) bronchioles, while pseudostratified ciliated cells extend to the _____ (repiratory/terminal) bronchioles.
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terminal; respiratory
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What type of pneumocyte makes up 97% of alveolar surfaces?
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Type I pneumocytes
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What type of pneumocyte makes up just 3% of pneumocytes?
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Type II pneumocytes
|
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What are two important functions of type II pneumocytes?
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To secrete surfactant and to serve as precursors to pneumocytes (both types I and II)
|
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What is dipalmitoyl phosphatidylcholine?
|
Surfactant
|
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What is the function of surfactant?
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To decrease alveolar surface tension
|
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Which cells proliferate to repair the lungs after they have been damaged?
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Type II pneumocytes
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What is the fate of mucus secreted within the respiratory tract?
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It gets swept out of the lungs and toward the mouth
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What feature of the pseudocolumnar cells of the respiratory tract allow them to move mucus toward the mouth?
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cilia
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What ratio of concentrations of which two molecules in amniotic fluid can be used as a marker of fetal lung maturity?
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The lecithin-to-sphingomyelin ratio
(> 2 implies maturity of the lungs) |
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Where is the lecithin-to-sphingomyelin ratio measured to assess fetal lung maturity?
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amniotic fluid
|
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A lecithin-to-sphingomyelin ratio with what value is indicative of fetal lung maturity?
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>2.0
|
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Histologically, while type I pneumocytes are _____ (cuboidal/squamous), type II pneumocytes are _____ (cuboidal/squamous).
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Squamous; cuboidal
(type one must be thin so that gas exchange can occur across them) |
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What is the advantage of having thin squamous cells that line the alveoli?
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They allow for optimal gas diffusion
|
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What are clara cells?
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Nonciliated columnar pneumocytes with secretory granules
|
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What are three functions of clara cells?
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They secrete a component of surfactant, degrade toxins, and act as reserve cells
|
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Which cells are responsible for clearing debris that accumulates in the alveoli?
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Macrophages
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In pulmonary gas exchange, _____ (carbon dioxide/oxygen) diffuses from the capillary lumen to the alveolar space, while _____ (carbon dioxide/oxygen) diffuses from the alveolar space to the capillary lumen.
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Carbon dioxide; oxygen
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In the lung, the endothelial cells are connected by _____ _____.
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Tight junctions
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Surfactant is secreted from the lamellar bodies of ____ (type I/type II/clara cell) pneumocytes.
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Type II
|
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What is the function of surfactant?
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To decrease alveolar surface tension
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An oxygen molecule is in the alveolus. In order, what cells will it cross to be able to bind to heme in the RBCs?
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To pass through the alveolar space to the capillary lumen, oxygen diffuses across the type I pneumocyte and then the endothelial cell
|
|
To pass through the alveolar space to the capillary lumen, oxygen diffuses across the type I pneumocyte and then the endothelial cell
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The majority of carbon dioxide will exit the RBC as bicarbonate (in exchange for chloride), cross the endothelial cell, then the type I pneumocyte to enter the alveolar space
|
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Along with pneumocytes, which phagocytic cells can be found in the alveolar space?
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macrophages
|
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Each bronchopulmonary segment has what three structures in the center?
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A tertiary bronchus and two arteries; remember the mnemonic: Arteries run with Airways
|
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What is another name for a tertiary bronchus?
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A segmental bronchus
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What two arteries are found in the center of each bronchopulmonary segment?
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A bronchial artery and a pulmonary artery
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What two structures are found along the borders of each bronchopulmonary segment?
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Veins and lymphatics
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Pulmonary _____ (arteries/veins) carry _____ (deoxygenated/oxygenated) blood from the right side of the heart to the lungs.
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Arteries; deoxygenated
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True or False: Pulmonary arterial pressure fluctuates depending on the stage of the cardiac cycle.
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False; elastic walls maintain relatively constant pulmonary arterial pressures during the entirety of the cardiac cycle
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How many lobes does the right lung have?
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Three
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How many lobes does the left lung have?
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two
|
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What structure does the left lung have that the right lung does not?
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A lingula; remember the mnemonic: Left has the Lingula
|
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Why is the right lung a more common site for an inhaled foreign body?
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The right main stem bronchus is wider and more vertical than the left one
|
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The left lung lacks what lobe?
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The middle lobe
|
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Instead of a middle lobe, the left lung has a space that is occupied by what?
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the heart
|
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Where is the pulmonary artery in relation to the bronchus within the right lung hilus?
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anterior (RALS- right anterior, left superior)
|
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Where is the pulmonary artery in relation to the bronchus within the left lung hilus?
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Superior
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In the right lung, the _____ (horizontal/oblique) fissure divides the superior lobe and the middle lobe.
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horizontal
|
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In the anterior aspect of the right lung, the oblique fissure divides which two lobes?
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The middle and the inferior lobes
|
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In the anterior aspect of the left lung, the oblique fissure divides which two lobes?
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The superior and the inferior lobes
|
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The horizontal fissure of the right lung is at the level of the _____ rib.
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Fourth
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In the posterior aspect of both the right and left lungs, the _____ (horizontal/oblique) fissure divides the superior and inferior lobes.
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oblique
|
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In the posterior aspect of the right and left lungs, the medial aspect of the oblique fissure is at the level of which vertebra?
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T2
|
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While both the right and left lungs have a(n) _____ (oblique/horizontal) fissure, only the right lung has a(n) _____ (oblique/horizontal) fissure.
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Oblique; horizontal
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A 5-year-old male presents after having aspirated a peanut while lying in bed. The peanut has most likely lodged in the _____ (lower/superior) portion of the (left/right) _____ (inferior/superior) _____ lobe.
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Superior; right; inferior
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A 33-year-old male presents after having aspirated a steak tip while sitting at the dinner table. The steak tip has most likely lodged in the (lower/superior) portion of the (left/right) (inferior/superior) lobe.
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Lower; right; inferior
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At what level does the inferior vena cava perforate the diaphragm?
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T8; remember the mnemonic: T8: vena cava (8 letters in vena cava)
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What two structures perforate the diaphragm at the level of T10?
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The esophagus and the vagus
|
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At what level does the esophagus perforate the diaphragm?
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T10; remember the mnemonic: T10: (o)esophagus [10 letters in (o)esophagus]
|
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At what level do the two trunks of the vagus perforate the diaphragm?
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T10
|
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What three structures perforate the diaphragm at the level of T12?
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The aorta, thoracic duct, and azygos vein; remember the mnemonic: T12: aortic hiatus (12 letters in aortic hiatus)
|
|
At what vertebral level does the aorta perforate the diaphragm?
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T12
|
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At what vertebral level does the thoracic duct perforate the diaphragm?
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T12
|
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At what vertebral level does the azygous vein perforate the diaphragm?
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T12
|
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Neurons from vertebral levels _____, _____, and _____ come together to form the phrenic nerve, which innervates the diaphragm.
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C3, C4, and C5; remember the mnemonic: "C3, 4, 5 keeps the diaphragm alive"
|
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Pain from the diaphragm can be referred to which anatomic region?
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shoulder
|
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Which tendon can be found on the inferior aspect of the diaphragm surrounding the caval and esophageal hiatuses?
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The central tendon
|
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What mnemonic can be used to recall the levels at which certain anatomic structures perforate the diaphragm relates?
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"I (IVC) ate (8) ten (10) eggs (espohagus) at (aorta) twelve (12)"
|
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During quiet breathing, what muscle is used for inspiration?
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The diaphragm
|
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During quiet breathing, what muscle is used for expiration?
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No muscles are used; the expiration of quiet breathing is passive
|
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During exercise, what three muscle groups are used for inspiration?
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The external intercostals, the scalene muscles, and the sternomastoids
|
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During exercise, what four abdominal wall muscle groups are for expiration?
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The rectus abdominus, the internal obliques, the external obliques, and the transversus abdominus
|
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During exercise, what chest wall muscles are used for expiration?
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The internal intercostals
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While expiration during quiet breathing is _____ (active/passive), expiration during exercise is _____ (active/passive).
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Passive; active
|
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What lung product is produced by type II pneumocytes?
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Surfactant
|
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True or False: Surfactant functions to decrease alveolar surface tension.
|
true
|
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True or False: Surfactant functions to decrease compliance.
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False; surfactant increases compliance
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True or False: Surfactant has no effect on the work of inspiration.
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False; it decreases the work of inspiration
|
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What lung product inactivates bradykinin?
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Angiotensin-converting enzyme
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What lung product activates bradykinin?
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Kallikrein
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In addition to inactivating bradykinin, what other reaction does angiotensin-converting enzyme catalyze?
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The conversion of angiotensin I to angiotensin II
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What effect do angiotensin-converting enzyme inhibitors have on serum levels of bradykinin?
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ACE inhibitors increase bradykinin levels-- leading to cough and angioedema
|
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Angiotensin-converting enzyme inhibitors increase bradykinin, which leads to which two common adverse effects?
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Cough and angioedema
|
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In addition to surfactant, angiotensin-converting enzyme, and kallikrein, what are two other important lung products?
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Prostaglandins and histamine
|
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What are two other names for surfactant?
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Dipalmitoyl phosphatidylcholine and lecithin
|
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A deficiency of surfactant leads to what neonatal condition?
|
Respiratory distress syndrome
|
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Give the equation for calculating collapsing pressure.
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Collapsing pressure = 2 × tension / radius
|
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What is the effect of histamine on the airways in the lung?
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Increases bronchoconstriction
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In the lung, _____ (angiotensin-converting enzyme/kallikrein) inactivates bradykinin, _____ (angiotensin-converting enzyme/kallikrein) activates bradykinin.
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Angiotensin-converting enzyme; kallikrein
|
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There is a tendency for the alveoli to collapse on _____ (expiration/inspiration) as the radius _____ (decreases/increases).
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expiration; decreases
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What is the term for the volume of air in the lungs after maximal expiration?
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Residual volume
|
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What is the term for the volume of air that can still be breathed out after normal expiration?
|
Expiratory reserve volume
|
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What is the term for the volume of air that moves into the lungs with each quiet inspiration?
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Tidal volume
|
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How much is the typical tidal volume?
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500 mL
|
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What is the term for the volume of air in excess of tidal volume that moves into the lung on maximum inspiration?
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Inspiratory reserve volume
|
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What is the term for the difference between the total lung capacity and residual volume called?
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Vital capacity
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Vital capacity equals the sum of what three lung volumes?
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Tidal volume, inspiratory reserve volume, and expiratory reserve volume
|
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The residual volume plus the expiratory reserve volume equals what?
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The functional reserve capacity
|
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Describe the functional reserve capacity.
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The volume left in the lungs after normal expiration
|
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The inspiratory reserve volume plus the tidal volume equals what?
|
Inspiratory capacity
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The inspiratory reserve volume plus the tidal volume plus the expiratory reserve volume plus the residual volume equals what?
|
Total lung capacity
|
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In reference to lung volume, what is the sum of two or more volumes called?
|
Capacity
|
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What is the term for the lung volume that includes all capacity except the residual volume?
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Vital capacity
|
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Which lung volume cannot be measured on spirometry: inspiratory reserve volume, tidal volume, expiratory reserve volume, or residual volume?
|
Residual volume
|
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Give the formula for calculating dead space volume.
|
Dead space volume = tidal volume × [(partial arterial pressure of carbon dioxide - partial expiratory pressure of carbon dioxide) / partial arterial pressure of carbon dioxide]
|
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Physiological dead space includes the anatomical dead space of the _____ (conducting/respiratory) airways plus the functional dead space in _____ (alveoli/bronchioles).
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Conducting; alveoli
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True or False: Physiologic dead space refers to inspired air that takes part in gas exchange.
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False; physiologic dead space refers to inspired air that does not take part in gas exchange
|
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Which section of the healthy lung contributes more to functional dead space: the apex or the base?
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The apex
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There is a tendency for lungs to collapse _____ (inward/outward) and the chest wall to spring _____ (inward/outward).
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Inward; outward
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At the point of functional residual capacity (i.e., at the end of a normal expiration), what is the value of the pressure within the lungs?
|
At FRC, the pressure within the lungs is equal to atmospheric pressure
|
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What balances the inward pull of the lung at the point of functional residual capacity (i.e. at the end of a normal expiration)?
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The outward pull of the chest wall
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How many polypeptide subunits make up hemoglobin?
|
four
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Adult hemoglobin is formed from two _____ subunits and two _____ subunits.
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alpha, beta
|
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What are the two conformation forms of hemoglobin?
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Relaxed and taut
|
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Which form of hemoglobin has a low affinity for oxygen, relaxed or taut?
|
Taut
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What shape is the hemoglobin-oxygen dissociation curve?
|
It is sigmoid shaped
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Which form of hemoglobin has a high affinity for oxygen, relaxed or taut?
|
relaxed
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True or False: Both hemoglobin and myoglobin share the same sigmoid-shaped oxygen binding curve.
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False; only hemoglobin has a sigmoid-shaped binding curve
|
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Does hemoglobin have positive or negative cooperativity?
|
Positive; the more oxygen molecules bind, the more affinity hemoglobin has for additional oxygen molecules
|
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Does a right shift of the hemoglobin-oxygen dissociation curve lead to increased or decreased oxygen unloading?
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Increased
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To increase oxygen unloading, should the hemoglobin-oxygen dissociation curve be shifted to the left or the right?
|
The right
|
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Fetal hemoglobin is composed of two ____ subunits and two ____ subunits.
|
α (alpha); γ (gamma-- babies go gaga)
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Does fetal hemoglobin have a higher or lower affinity for oxygen as compared with adult hemoglobin?
|
higher
|
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Does fetal hemoglobin have a higher or lower affinity for 2,3-biphosphoglycerate as compared with adult hemoglobin?
|
lower
|
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An increase in which 5 factors will favor the taut form of hemoglobin over the relaxed form?
|
Cl-, H+, CO2, 2,3-BPG, and temperature
|
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Favoring the taut form of hemoglobin over the relaxed form will cause the dissociation curve to shift in which direction?
|
Right
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An _____ (increase/decrease) in Cl-, H+, CO2, 2,3-BPG, and temperature will cause the oxygen dissociation curve to shift to the left.
|
decrease
|
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Which form of hemoglobin will lead to decreased oxygen unloading?
|
relaxed-- increased affinity for o2
|
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Does carbon dioxide bind to the globin or heme portion of the hemoglobin molecule?
|
Globin
|
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Does carbon dioxide binding to hemoglobin promote the stability of the taut or relaxed form?
|
taut- to increase unloading of O2 at sites with high CO2 production/metabolic demand
|
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True or False: Carbon dioxide binds to the N terminus of the globin molecule.
|
true
|
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Does carbon dioxide binding to hemoglobin promote or inhibit the unloading of oxygen?
|
It promotes the unloading of oxygen, via negative allosteric regulation
|
|
What is the direction of the net transport of carbon dioxide between the lungs and the peripheral tissues?
|
From the tissues to the lungs; the opposite of net oxygen movement
|
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What is the primary form of carbon dioxide as it is transported in the blood from the peripheral tissues to the lungs?
|
Bicarbonate
|
|
Does hemoglobin contain iron in the oxidized state or in the reduced state?
|
The reduced state
(Fe2+) |
|
Does hemoglobin contain Fe2+ or Fe3+?
|
Fe2+
|
|
Does hemoglobin contain ferric iron or ferrous iron?
|
Ferrous iron (Fe2+)
|
|
Does methemoglobin contain iron in the oxidized state or the reduced state?
|
The oxidized state
(Fe3+)-- cannot carry oxygen as well, but carries CN- much better |
|
Does methemoglobin contain Fe2+ or Fe3+?
|
Fe3+
|
|
Does methemoglobin contain ferric iron or ferrous iron?
|
Ferric iron
(fe3+) |
|
Hemoglobin contains _____ (ferric/ferrous) iron, whereas methemoglobin contains _____ (ferric/ferrous) iron.
|
Ferrous; ferric
|
|
What are the mechanisms of action of nitrites and thiosulfate in the treatment of cyanide poisoning?
|
Nitrites oxidize the iron in hemoglobin to form methemoglobin; methemoglobin then binds to cyanide ions, which in turn allows cytochrome oxidase to function; after administering nitrites, thiosulfate is used to bind to the cyanide-methemoglobin complexes, to form thiocyanate, which is renally excreted
|
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Hemoglobin contains ____ (Fe2+/Fe3+), whereas methemoglobin contains ____ (Fe2+/Fe3+).
|
Fe2+; Fe3+
|
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When another molecule, such as CO, binds to hemoglobin in place of oxygen, what are the systemic effects?
|
This leads to tissue hypoxia from decreased oxygen saturation and decreased oxygen content in the blood
|
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Hemoglobin contains iron that is _____ (oxidized/reduced), whereas methemoglobin contains iron that is _____ (oxidized/reduced).
|
Reduced; oxidized
|
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Which has a higher affinity for oxygen, hemoglobin or methemoglobin?
|
Hemoglobin
|
|
What is the treatment for toxic levels of methemoglobin?
|
Methylene blue; remember the mnemonic: METHemoglobinemia can be treated with METHylene blue
|
|
Which has a higher affinity for cyanide, hemoglobin or methemoglobin?
|
Methemoglobin
|
|
What is the name of a form of hemoglobin in which carbon monoxide is bound instead of oxygen?
|
Carboxyhemoglobin
|
|
True or False: Carbon monoxide has a greater affinity for hemoglobin than oxygen does.
|
True; CO has 200x the affinity of oxygen
|
|
Nitrates are used to treat cyanide poisoning because these drugs oxidize hemoglobin into methemoglobin. The production of methemoglobin allows which enzyme to function?
|
Cytochrome oxidase
|
|
In treating cyanide poisoning, ______ is the compound used to bind cyanide, forming _____ which is a renally excretable compound.
|
Thiosulfate; thiocyanate
|
|
What is the treatment for cyanide poisoning?
|
Nitrites, and subsequently thiosulfate
|
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The formation of carboxyhemoglobin is associated with a _____ (left/right) shift in the oxygen-hemoglobin dissociation curve, which causes _____ (decreased/increased) oxygen-binding capacity, and thus _____ (decreased/increased) oxygen unloading in tissues.
|
Left; decreased; decreased
|
|
When the oxygen-hemoglobin dissociation curve shifts to the right, what happens to the affinity of hemoglobin for oxygen?
|
A right shift decreases the affinity of hemoglobin for oxygen
|
|
When the oxygen-hemoglobin dissociation curve shifts to the right, what happens to the P50?
|
A right shift increases the P50, indicating that higher oxygen pressure is required to saturate hemoglobin
|
|
A shift of the oxygen-hemoglobin dissociation curve to the right facilitates what process in tissue?
|
The unloading of oxygen to tissue
|
|
When the oxygen-hemoglobin dissociation curve shifts to the left, what happens to the affinity of hemoglobin for oxygen?
|
A left shift increases the affinity of hemoglobin for oxygen
|
|
When the oxygen-hemoglobin dissociation curve shifts to the left, what happens to the P50?
|
A left shift decreases the P50; hemoglobin is saturated at lower pressures of oxygen
|
|
A decrease in metabolic needs causes a _____ (left/right) shift of the oxygen-hemoglobin dissociation curve.
|
Left
|
|
A decrease in the partial pressure of carbon dioxide causes a _____ (left/right) shift in the oxygen-hemoglobin dissociation curve.
|
Left
|
|
A decrease in temperature causes a _____ (left/right) shift in the oxygen-hemoglobin dissociation curve.
|
Left
|
|
A decrease in hydrogen causes a _____ (left/right) shift in the oxygen-hemoglobin dissociation curve?
|
Left
|
|
A decrease in pH causes a _____ (left/right) shift in the oxygen-hemoglobin dissociation curve.
|
Right
|
|
A decrease in 2,3-diphosphoglycerate causes a _____ (left/right) shift in the oxygen-hemoglobin dissociation curve.
|
Left
|
|
The oxygen-hemoglobin dissociation curve for fetal hemoglobin is shifted in what direction?
|
Left; fetal hemoglobin has higher affinity for oxygen than adult hemoglobin
|
|
When the oxygen-hemoglobin dissociation curve shifts to the right, what happens to the affinity of hemoglobin for oxygen?
|
A right shift decreases the affinity of hemoglobin for oxygen
|
|
An increase in metabolic needs causes a _____ (left/right) shift in the oxygen-hemoglobin dissociation curve.
|
Right
|
|
An increase in the partial pressure of carbon dioxide causes a _____ (left/right) shift in the oxygen-hemoglobin dissociation curve.
|
right
|
|
An increase in temperature causes a _____ (left/right) shift in the oxygen-hemoglobin dissociation curve.
|
right
|
|
An increase in hydrogen causes a _____ (left/right) shift in the oxygen-hemoglobin dissociation curve.
|
right
|
|
An increase in pH causes a ______ (left/right) shift in the oxygen-hemoglobin dissociation curve.
|
left
|
|
High altitude induces what change in the oxygen-hemoglobin dissociation curve?
|
right shift
|
|
An increase in the partial pressure of carbon dioxide causes a _____ (left/right) shift in the oxygen-hemoglobin dissociation curve.
|
right
|
|
An increase in temperature causes a _____ (left/right) shift in the oxygen-hemoglobin dissociation curve.
|
right
|
|
An increase in hydrogen causes a _____ (left/right) shift in the oxygen-hemoglobin dissociation curve.
|
right
|
|
An increase in pH causes a ______ (left/right) shift in the oxygen-hemoglobin dissociation curve.
|
left
|
|
High altitude induces what change in the oxygen-hemoglobin dissociation curve?
|
right shift
|
|
An increase in 2,3-diphosphoglycerate causes a _____ (left/right) shift in the oxygen-hemoglobin dissociation curve.
|
right
|
|
In the oxygen-hemoglobin dissociation curve, what values are represented by the x and y axes?
|
The partial pressure of oxygen represents the x axis, while hemoglobin saturation represents the y-axis
|
|
Hemoglobin can bind 4 oxygen molecules and has a higher affinity for each subsequent oxygen molecule bound. What is the term for this phenomenon?
|
Positive cooperativity
|
|
An increase in the amounts of which 6 factors causes a right shift of the oxygen-hemoglobin dissociation curve?
|
CO2, hydrogen ions (therefore acidity), altitude, 2,3-DPG, metabolic needs (i.e., exercise), and temperature; remember the mnemonic: CADET face right: CO2, Acid/Altitude, DPG (2,3-DPG), Exercise, Temperature
|
|
Normally, pulmonary circulation is a _____ (high/low) resistance, _____ (high/low) compliance system.
|
Low; high
|
|
Within the lungs, a decrease in the partial pressure of oxygen in arterial blood causes what process to occur within the vasculature in the area?
|
Hypoxic vasoconstriction
--- to shift blood to areas that are ventilated and thus can contribute positively to blood oxygen levels |
|
Within the lungs, hypoxic vasoconstriction serves what physiologic function?
|
It shifts blood away from the poorly ventilated regions of the lung to the well-ventilated regions of the lung
|
|
Under normal, healthy conditions, is oxygen a perfusion-limited gas or a diffusion-limited gas?
|
Perfusion-limited gas
|
|
Is carbon dioxide a perfusion-limited gas or a diffusion-limited gas?
|
Perfusion-limited gas
|
|
Is nitrous oxide a perfusion-limited gas or a diffusion-limited gas?
|
Perfusion-limited gas
|
|
Is carbon monoxide a perfusion-limited gas or a diffusion-limited gas?
|
Diffusion-limited gas
|
|
Under conditions of strenuous exercise, is oxygen a perfusion-limited gas or a diffusion-limited gas?
|
Diffusion-limited gas
|
|
Under what condition is oxygen a perfusion-limited gas?
|
In normal health
|
|
Under perfusion-limited conditions, where along the length of the capillary do the partial pressures of a gas equilibrate?
|
early
|
|
Under perfusion-limited conditions, how can gas exchange be increased?
|
By increasing blood flow
|
|
True or False: Under perfusion-limited conditions, the only way to increase diffusion is to increase blood flow.
|
True
|
|
List two gases that can be diffusion limited.
|
Oxygen and carbon monoxide
|
|
Under what conditions is oxygen a diffusion-limited gas?
|
Exercise, emphysema, and fibrosis
|
|
Under diffusion-limited conditions, where along the length of the capillary does the gas equilibrate?
|
Nowhere; it does not equilibrate by the time the blood reaches the end
|
|
True or False: Under diffusion-limited conditions, the gas does not equilibrate by the time the blood reaches the end of the capillary.
|
true
|
|
What are the cardiac complications of pulmonary hypertension?
|
Cor pulmonale and right ventricular failure
|
|
True or False: Pulmonary edema is a sign of right heart failure.
|
False; it is a sign of left heart failure
|
|
True or False: Jugular venous distention is a sign of left heart failure.
|
True; but it can be a sign of right heart failure as well
--typically we think of it as a sign of right heart failure with blood backing up through SVC and into the jugular veins |
|
What are three signs of right ventricular heart failure due to cor pulmonale?
|
Jugular venous distention, edema, and hepatomegaly
|
|
What is the equation for diffusion of a gas across a membrane?
|
Vgas = A/T × Dk(P1 - P2), where A = area, T = thickness, and Dk(P1 - P2) = difference in partial pressures
|
|
In the equation for gas diffusion, which variable is affected by emphysema and how?
|
Area of membranes available for gas transfer is decreased in emphysema, causing a decrease in diffusion
|
|
In the equation for gas diffusion, which variable is affected by pulmonary fibrosis and how?
|
Thickness of the membrane is increased in pulmonary fibrosis, causing a decrease in diffusion
|
|
What is normal pulmonary arterial pressure?
|
10-14 mm Hg
|
|
What pulmonary artery pressures define pulmonary hypertension?
|
25 mm Hg or greater during rest and >35 mm Hg during exercise
|
|
Primary pulmonary hypertension is caused by what?
|
An inactivating mutation in the BMPR2 gene, which normally functions to inhibit vascular smooth muscle proliferation
|
|
Does primary pulmonary hypertension have a good or a poor prognosis?
|
Very poor; the disease is progressive and fatal
|
|
What are some of the potential causes of secondary pulmonary hypertension?
|
Chronic obstructive pulmonary disease, left-to-right shunt, mitral stenosis, recurrent thromboemboli, autoimmune disease (i.e., systemic sclerosis), sleep apnea, or living at high altitudes
|
|
What are three pathological changes in the vasculature caused by pulmonary hypertension?
|
Atherosclerosis, medial hypertrophy, and intimal fibrosis of the pulmonary arteries
|
|
How does COPD cause pulmonary hypertension?
|
By the destruction of lung parenchyma and subsequent vasoconstriction due to hypoxia
|
|
How does mitral stenosis cause pulmonary hypertension?
|
By increasing resistance to blood flow in the left heart; thus causing a build-up of pressure starting in the left atrium and backing up to the pulmonary vasculature
|
|
How do recurrent thromboemboli cause pulmonary hypertension?
|
By decreasing the cross-sectional area of the pulmonary vascular bed
|
|
How can autoimmune disease cause pulmonary hypertension?
|
Processes such as systemic sclerosis lead to inflammation, then to intimal fibrosis, which in turn leads to medial hypertrophy in the pulmonary vasculature
|
|
How does left-to-right shunt cause pulmonary hypertension?
|
By causing increased shear stress (due to increased volume in the right ventricle), and thus endothelial injury
|
|
How do sleep apnea or living at high altitudes cause pulmonary hypertension?
|
Sleep apnea and living at high altitudes cause hypoxia, which in turn causes pulmonary vasoconstriction
|
|
What are the sequelae of pulmonary hypertension if left untreated?
|
Severe respiratory distress, leading to cyanosis and right ventricular hypertrophy, leading to death from decompensated cor pulmonale
|
|
What enters RBCs to allow HCO3- (bicarbonate) to exit?
|
Cl- (chloride shift) to maintain charge neutrality-- one anion leaves and another is taken in
|
|
How is pulmonary vascular resistance calculated?
|
Pulmonary vascular resistance = (pressure in the pulmonary artery minus pressure in the left atrium) divided by the cardiac output
|
|
Pressure in the left atrium is equal to what measurement of pulmonary venous resistance?
|
Wedge pressure
|
|
Pulmonary vascular resistance is _____ (directly/inversely) related to airway length and _____ (directly/inversely) related to vessel radius.
|
Directly; inversely
|
|
Which two factors increase pulmonary vascular resistance?
|
Increased viscosity of blood and increased vessel length
|
|
What enters RBCs to allow HCO3- (bicarbonate) to exit?
|
Cl- (chloride shift) to maintain charge neutrality-- one anion leaves and another is taken in
|
|
How is pulmonary vascular resistance calculated?
|
Pulmonary vascular resistance = (pressure in the pulmonary artery minus pressure in the left atrium) divided by the cardiac output
|
|
Pressure in the left atrium is equal to what measurement of pulmonary venous resistance?
|
Wedge pressure
|
|
Pulmonary vascular resistance is _____ (directly/inversely) related to airway length and _____ (directly/inversely) related to vessel radius.
|
Directly; inversely
|
|
Which two factors increase pulmonary vascular resistance?
|
Increased viscosity of blood and increased vessel length
|
|
What is the equation for resistance, given vessel length, diameter, and blood viscosity?
|
R = (8ηl) / (πr4), where η = viscosity of blood, l = vessel length, and r = vessel radius
|
|
How is the oxygen content of the blood calculated?
|
Oxygen content of the blood = (oxygen-binding capacity × percent saturation) + dissolved oxygen
|
|
How much oxygen can 1 g of hemoglobin bind?
|
1.34 mL
|
|
What is the average amount of hemoglobin in normal blood?
|
About 15 g/dL
|
|
What is the normal oxygen-binding capacity of the blood?
|
About 20.1 mL oxygen/dL of blood
|
|
True or False: When the hemoglobin level falls, the oxygen content of the blood falls.
|
True, because oxygen-binding capacity depends on the total amount of hemoglobin
|
|
True or False: When the hemoglobin level falls, the percent oxygen saturation of the blood falls.
|
False; the blood can still be 100% saturated; there will be less oxygen binding capacity and hence lower oxygen content
|
|
A decrease in hemoglobin will have what effect on the oxygen content of arterial blood: decrease, increase, or no change?
|
decrease
|
|
A decrease in hemoblogin will have what effect on oxygen saturation: decrease, increase, or no change?
|
no change
|
|
A decrease in hemoglobin will have what effect on partial oxygen pressure: decrease, increase, or no change?
|
no change
|
|
Visible cyanosis typically results when deoxygenated hemoglobin is at what level?
|
> 5 g/dL
|
|
Why does arterial partial pressure of oxygen decrease with chronic lung disease?
|
Physiologic shunt decreases the oxygen extraction ratio
|
|
What is the formula for oxygen delivery to tissues?
|
Oxygen delivery to tissues = cardiac output × oxygen content of blood
|
|
What is the alveolar gas equation?
|
Alveolar partial pressure of oxygen (in mm Hg) = the partial pressure of oxygen in inspired air minus (alveolar partial carbon dioxide pressure divided by the respiratory quotient); or, PAo2 = PIo2 - (PAco2 / R)
|
|
How can the alveolar gas equation be simplified and approximated (assuming that the patient is on room air)?
|
Alveolar partial pressure of oxygen = 150 - (arterial partial pressure of carbon dioxide / 0.8)
|
|
What gradient is equal to the alveolar partial pressure of oxygen minus the arterial partial pressure of oxygen?
|
The alveolar-arterial gradient (the A-a gradient)
|
|
What is the normal alveolar-arterial gradient?
|
10-15 mmHg
|
|
What three pathological processes can lead to increased A-a gradient?
|
Shunting, V/Q mismatch, and fibrosis of the lungs
|
|
Name 5 processes that can lead to hypoxemia (i.e., decreased arterial oxygen).
|
High altitude, hypoventilation, V/Q mismatch, diffusion limitation, and right-to-left shunt
|
|
Name 5 processes that can lead to hypoxia (i.e. decreased oxygen delivery to tissue).
|
Decreased cardiac output, hypoxemia, anemia, cyanide poisoning, and carbon monoxide poisoning
|
|
Name 2 processes that can lead to ischemia (i.e. loss of blood flow)
|
Impeded arterial flow, and reduced venous drainage
|
|
What is the difference between hypoxemia and hypoxia?
|
Hypoxemia refers to decreased arterial partial pressure of oxygen and can lead to hypoxia, which is defined as decreased oxygen delivery to tissue
|
|
Which 2 processes lead to hypoxemia with a normal A-a gradient?
|
High altitude and hypoventilation
|
|
Which 3 processes can lead to hypoxemia with an increased A-a gradient?
|
V/Q mismatch, diffusion limitation (e.g. fibrosis), and right-to-left shunt
|
|
Ideally, adequate gas exchange requires _____ to be in equilibrium with _____.
|
Ventilation; perfusion
|
|
The equation V/Q = 1 represents what condition?
|
Ventilation that is matched with perfusion
|
|
Within what part of the lung does ventilation/perfusion equal about 3?
|
The apex of the lung
|
|
In the apex of the lung, there is wasted _____ (perfusion/ventilation).
|
ventilation
|
|
Within what part of the lung does ventilation/perfusion equal about 0.6?
|
base
|
|
In the base of the lung, there is wasted _____ (perfusion/ventilation).
|
perfusion
|
|
Is ventilation greater at the base of the lung or the apex of the lung?
|
base
|
|
Is perfusion greater at the base of the lung or the apex of the lung?
|
base of the lung
|
|
With exercise, what happens to the apical capillaries?
|
They vasodilate resulting in a V/Q ratio that approaches 1
|
|
The vasodilation of the apical capillaries that occurs with exercise results in what change to the ventilation/perfusion ratio?
|
The V/Q ratio approaches 1
|
|
Microorganisms that thrive in high-oxygen environments, such as tuberculosis, flourish in which part of the lungs?
|
apex
|
|
True or False: Tuberculosis is an example of an organism that thrives in the high-oxygen environment of the apical lungs.
|
true
|
|
A ventilation/perfusion ratio that approaches 0 for a given area of lung indicates that what is occurring in that area?
|
airway obstruction-- there is no ventilation, but there is perfusion
|
|
What is the name for the process whereby airway obstruction leads to perfusion with no ventilation within an area of the lungs?
|
shunt
|
|
A ventilation/perfusion ratio that approaches infinity for a given area of lung indicates that what is occurring in that area?
|
Blood flow obstruction (i.e., pulmonary embolus)
(dead space) |
|
When blood flow (but not airflow) into an area of the lungs is obstructed such that the ventilation/perfusion ratio approaches infinity, the area can be considered what?
|
dead space
|
|
Which zone of the lung is associated with wasted ventilation?
|
the apex/zone 1
|
|
Which zone of the lung is associated with wasted perfusion?
|
the base/ zone 3
|
|
In hypoxia due to _____ (dead space/shunting), 100% oxygen does not improve the partial pressure of oxygen; while in hypoxia due to increased _____ (dead space/shunting), there is an improvement in the partial pressure of oxygen.
|
shunting; deadspace
|
|
In the lung apex (zone 1), arrange the following in order of increasing pressure: artery, vein, alveolus.
|
Vein < artery< alveolus
|
|
In zone 2 of the lung, arrange the following in order of increasing pressure: artery, vein , alveolus
|
Vein < alveolus < artery
|
|
In the lung base (zone 3), arrange the following in order of increasing pressure: artery, vein, alveolus.
|
Alveolus < vein < artery
|
|
What process causes the ventilation at the apex of the lungs to be considered "wasted?"
|
The high alveolar pressure at the apex causes compression of the capillaries, and thus an inability to undertake gas exchange with the blood vessels
|
|
In how many different forms is carbon dioxide transported from the tissues to the lungs?
|
Three: (1) as bicarbonate, (2) bound to hemoglobin as carbaminohemoglobin, and (3) dissolved
|
|
Ninety percent of the carbon dioxide transported from the tissues to the lungs is in what form?
|
Bicarbonate
|
|
Other than as bicarbonate, in what two other ways is carbon dioxide transported from the tissues to the lungs?
|
Bound to hemoglobin as carbaminohemoglobin and dissolved as carbon dioxide
|
|
What is carbon dioxide that is bound to hemoglobin called?
|
Carbaminohemoglobin
|
|
What percentage of carbon dioxide gets transported from the tissues to the lungs as carbaminohemoglobin?
|
About 5%
|
|
What percentage of carbon dioxide gets transported from the tissues to the lungs as dissolved carbon dioxide?
|
About 5%
|
|
After it is inside an RBC, each carbon dioxide molecule combines with a molecule of what compound?
|
Water
|
|
After it is inside an RBC, each carbon dioxide molecule combines with a water molecule to become what compound?
|
Carbonic acid (H2CO3)
|
|
What enzyme catalyzes the conversion of carbon dioxide and water into carbonic acid?
|
Carbonic anhydrase
|
|
Within an RBC, the carbonic acid formed from the combination of carbon dioxide and water dissociates into what two compounds?
|
Hydrogen and bicarbonate
|
|
What is the fate of the bicarbonate that results from the deprotonation of carbonic acid within an RBC?
|
It gets exchanged out of the RBC for a chloride molecule that enters the RBC
|
|
In the lungs, the oxygenation of hemoglobin promotes what?
|
The dissociation of a proton from hemoglobin and hence a decrease in pH
|
|
What is the name for the effect in which the oxygenation of hemoglobin within the lungs promotes the dissociation of carbon dioxide from hemoglobin?
|
The Haldane effect
|
|
In reference to carbon dioxide transport, in which direction will the lower pH of peripheral tissues (compared ot the lungs) shift the oxygen dissociation curve?
|
to the right
|
|
In peripheral tissues, the right shift of the hemoglobin dissociation curve that results from lower pH promotes what?
|
unloading of Oxygen
|
|
In peripheral tissues, the right shift of the oxygen dissociation curve that results from decreased pH causes an unloading of oxygen. What is this effect called?
|
The Bohr effect
|
|
Acutely, what happens to ventilation as a response to high altitude?
|
Ventilation is increased --> respiratory alkalosis
|
|
Chronically, what happens to ventilation as a response to high altitude?
|
Ventilation is increased
|
|
What happens to erythropoietin levels as a response to high altitude?
|
increased
|
|
What two laboratory parameters increase as a result of the increased erythropoietin levels that result from being at high altitudes?
|
Hematocrit and hemoglobin
|
|
What happens to the level of 2,3-diphosphoglycerate in response to high altitude?
|
increases
|
|
What substance binds to hemoglobin so that hemoglobin releases more oxygen?
|
2,3-Diphosphoglycerate; increased concentrations shift the hemoglobin dissociation curve to the right
|
|
What cellular changes occur in response to high altitude?
|
There is an increase in mitochondria
|
|
Increased renal excretion of what substance occurs in response to high altitude?
|
Bicarbonate- to compensate for the respiratory alkalosis
|
|
The increased renal excretion of bicarbonate that is seen in response to high altitude compensates for what?
|
The respiratory alkalosis that occurs as a result of increased ventilation
|
|
The increased renal excretion of bicarbonate that is seen in response to high altitude can be augmented using what?
|
Acetazolamide; the drug is a carbonic anhydrase inhibitor that makes the urine more basic
|
|
In response to high altitude, chronic hypoxic pulmonary vasoconstriction results in what condition?
|
Right ventricular hypertrophy
|
|
As a result of exercise, what happens to carbon dioxide production in muscles?
|
increases
|
|
In response to exercise, what happens to oxygen consumption?
|
increases
|
|
Why does ventilation rate increase during exercise?
|
In order to meet increasing oxygen demand
|
|
What happens to the V/Q ratio as a response to exercise?
|
It becomes more uniform from apex to base; hence gas exchange is more efficient
|
|
What happens to pulmonary blood flow as a response to exercise?
|
It increases due to increased cardiac output
|
|
True or False: pH rises during strenuous exercise.
|
False; pH decreases during stenuous exercise due to lactic acidosis
|
|
True or False: PaO2 and PaCO2 increase in response to exercise, while venous CO2 content decreases.
|
False; PaO2 and PaCO2 do not change in response to exercise but venous CO2 content increases
|
|
What is the hallmark pulmonary function test finding in patients with obstructive lung disease?
|
Decreased FEV1:FVC ratio
|
|
Is chronic bronchitis considered an obstructive lung disease or a restrictive lung disease?
|
Obstructive
|
|
Is emphysema considered an obstructive lung disease or a restrictive lung disease?
|
Obstructive
|
|
Is asthma considered an obstructive lung disease or a restrictive lung disease?
|
Obstructive
|
|
Is bronchiectasis considered an obstructive lung disease or a restrictive lung disease?
|
Obstructive
|
|
In obstructive lung disease, there is a(n) _____ (decrease/increase) in residual volume and a(n) ____ (decrease/increase) in functional vital capacity.
|
Increase; decrease
|
|
A patient with chronic bronchitis is sometimes referred to as a "_____ _____," whereas a patient with emphysema is sometimes referred to as a "_____ _____."
|
Blue bloater; pink puffer
|
|
What type of cough do patients with chronic bronchitis tend to have?
|
A chronic productive cough
|
|
To be diagnosed with chronic bronchitis, a patient must have had a productive cough for how long?
|
At least 3 consecutive months in at least 2 years
|
|
Patients with chronic bronchitis have hypertrophy of what glands in what segments of the lungs?
|
The mucus-secreting glands in the bronchioles
|
|
The gland hypertrophy seen in chronic bronchitis can be quantified using the _____ _____, which tends to be greater than what value in symptomatic patients?
|
Reid index; 50%
|
|
What is the leading cause of chronic bronchitis?
|
Smoking
|
|
True or False: Stridor is often auscultated in the lungs of patients with chronic bronchitis.
|
False; the exam findings are usually wheezing and crackles
(stridor is an inspiratory breath sound hear with epiglotitis) |
|
True or False: Wheezing is often auscultated in the lungs of patients with chronic bronchitis.
|
true
|
|
True or False: Crackles are often auscultated in the lungs of patients with chronic bronchitis.
|
true
|
|
What visible skin finding may be noted in patients with chronic bronchitis?
|
cyanosis
|
|
Emphysema involves an enlargement of the air spaces and a decrease in recoil that results from the destruction of the _____ _____.
|
Alveolar walls
|
|
Emphysema can be caused by what lifestyle choice and in what genetic disease?
|
Smoking and α1-antitrypsin deficiency
|
|
Smoking is associated with _____ (centriacinar/panacinar) -type emphysema, whereas α1-antitrypsin deficiency is associated with _____ (centriacinar/panacinar) -type emphysema.
|
Centriacinar; panacinar
|
|
In addition to panacinar emphysema, α1-antitrypsin deficiency also causes what condition?
|
Liver cirrhosis
|
|
A deficiency of α1-antitrypsin results in the increased activity of what enzyme?
|
Elastase; the enzyme degrades elastic fibers in the lungs-- produced and released by neutrophils
|
|
True or False: Stridor is often auscultated in the lungs of patients with emphysema.
|
False; breath sounds are usually diminished with a decreased inspiratory-to-expiratory ratio
|
|
True or False: Decreased breath sounds are often auscultated in the lungs of patients with emphysema.
|
true
|
|
True or False: A decreased inspiratory-to-expiratory ratio is often noted in the lungs of patients with emphysema.
|
true
|
|
True or False: Wheezing is often auscultated in the lungs of patients with emphysema.
|
False; wheezing is associated with chronic bronchitis and asthma
|
|
True or False: Crackles are often auscultated in the lungs of patients with emphysema.
|
False; crackles are associated with chronic bronchitis
|
|
In emphysemic lungs, there is a(n) (decrease/increase) _____ in recoil and, subsequently, a(n) _____ (decrease/increase) in compliance.
|
Decrease; increase
|
|
In emphysema, the decrease in lung recoil is a result of destruction of alveolar walls by increased activity of which enzyme?
|
Elastase
|
|
Paraseptal emphysema is associated with bullae that can rupture and lead to _____ _____ in otherwise young healthy males.
|
Spontaneous pneumothorax
|
|
Individuals with emphysema tend to exhale through pursed lips to increase _____ _____ and prevent _____ _____ during expiration.
|
Airway pressure; airway collapse
|
|
In patients with asthma, bronchial hyperresponsiveness causes reversible _____ (constriction/dilation) of the bronchioles.
|
Constriction
|
|
The definitive feature of the bronchoconstriction of asthma is that it is fully _____.
|
Reversible
|
|
In patients with asthma, there is hyperresponsiveness of what lung segment?
|
The bronchi
|
|
While chronic bronchitis is a disease of the _____ (bronchi/bronchioles), asthma is a disease of _____ (bronchi/bronchioles).
|
Bronchioles; bronchi
|
|
True or False: Kartagener's syndrome is a granulomatous condition that can cause interstitial lung disease.
|
False; Kartagener's syndrome is associated with bronchiectasis and obstructive lung disease
|
|
blocks viral penetration/uncoating(M2 protein) may buffer pH of endosome. also causes the release of dopamine from intact nerve terminals
|
Amantadine
|
|
True or False: Patients with asthma are often bradycardic.
|
False; patients with asthma are often tachycardic
|
|
What finding is commonly noted on pulmonary function testing of patients with asthma as well as those with emphysema?
|
Decreased inspiratory-to-expiratory ratio
|
|
What blood pressure/pulse finding is often observed in patients with asthma?
|
Pulsus paradoxus
|
|
What eponymous pathology finding is associated with asthma?
|
Curschmann's spirals (shed epithelium from mucous plugs)
|
|
What two pathologic findings are associated with asthma?
|
Smooth muscle hypertrophy and mucous plugging
|
|
_____ is a chronic necrotizing infection of bronchi.
|
Bronchiectasis
|
|
In bronchiectasis, chronic necrotizing infection of the bronchi leads to what?
|
Permanent dilation of the airways
|
|
Patients with bronchiectasis often have a cough productive of what?
|
Blood and purulent sputum
|
|
Which two pathologic conditions are associated with bronchiectasis?
|
Cystic fibrosis and Kartagener's syndrome
|
|
True or False: Bronchiectasis is associated with bronchial obstruction.
|
true
|
|
True or False: Bronchiectasis is associated with poor ciliary motility.
|
true
|
|
Individuals with bronchiectasis are prone to develop which fungal pulmonary infection?
|
Aspergillosis
|
|
What are three common triggers of asthma attacks?
|
Viral URIs, allergens, and stress
|
|
Chronic bronchitis is associated with _____ (early/late)-onset hypoxemia and _____ (early/late)-onset dyspnea.
|
Early; late
|
|
Emphysema is associated with ________ (early/late)-onset hypoxemia and ________ (early/late)-onset dyspnea.
|
Late; early
|
|
What causes late-onset hypoxemia in emphysema?
|
The eventual loss of capillary beds, which occurs with the loss of alveolar walls
|
|
What causes early-onset hypoxemia in chronic bronchitis?
|
shunting
|
|
Patients with _____ (emphysema/chronic bronchitis) feel dyspneic earlier in the course of the disease.
|
Emphysema
|
|
In restrictive lung disease, there is restricted lung _____ that causes decreased lung volume.
|
Expansion
|
|
What two lung volumes are typically decreased in patients with restrictive lung disease?
|
Functional vital capacity and total lung capacity
|
|
Patients with restrictive lung disease typically have an FEV1:FVC within what range?
|
>80%
|
|
What are the two general types of restrictive lung disease?
|
Poor breathing mechanics (caused by musculoskeletal or connective tissue disease) and interstitial lung diseases
|
|
Extrapulmonary causes of restrictive lung disease are generally the result of what?
|
Poor breathing mechanics, usually as a result of muscular dysfunction (eg, polio) or structural difficulty (eg, scoliosis, morbid obesity)
|
|
Pulmonary causes of restrictive lung disease are generally the result of what category of diseases?
|
Interstitial lung diseases
|
|
What infectious disease can cause poor muscular effort and thereby lead to extrapulmonary restrictive lung disease?
|
Polio
|
|
What disease of the neuromuscular junction can cause poor muscular effort and thereby lead to extrapulmonary restrictive lung disease?
|
Myasthenia gravis
|
|
True or False: Sarcoidosis can lead to poor muscular effort and thereby lead to extrapulmonary restrictive lung disease.
|
False; sarcoidosis is an interstitial restrictive lung disease
|
|
True or False: Scoliosis can cause poor structural apparatus and thereby lead to extrapulmonary restrictive lung disease.
|
True
|
|
True or False: Morbid obesity can cause poor structural apparatus and thereby lead to extrapulmonary restrictive lung disease.
|
True
|
|
True or False: Polio is an intrapulmonary process that can result in restricted lung expansion.
|
False; polio is an extrapulmonary process
|
|
True or False: Adult respiratory distress syndrome is an intrapulmonary process that can result in restricted lung expansion.
|
True
|
|
True or False: Neonatal respiratory distress syndrome is an intrapulmonary process that can result in restricted lung expansion.
|
True
|
|
What is another name for neonatal respiratory distress syndrome?
|
Hyaline membrane disease
|
|
What category of interstitial lung diseases has a clear association with an environmental exposure?
|
Pneumoconioses
|
|
used in combination with sulfonamides (TMP-SMX) causing sequential block of folate synthesis
-combo used in for what organisms? |
trimethoprim
used or UTI'S shigella, salmonella, pneumocystis carinii pneumonia |
|
True or False: Eosinophilic granuloma is an example of a pneumoconiosis.
|
False; it is an example of interstitial lung disease
|
|
True or False: Asbestosis is an example of a pneumoconiosis.
|
true
|
|
True or False: Sarcoidosis is a granulomatous condition that can cause interstitial lung disease.
|
true- non-caseating granulomas- hilar adenopathy (more common in african american females)
|
|
True or False: Wegener's granulomatosis is a granulomatous condition that can cause interstitial lung disease.
|
true
|
|
used against TB
delays reasistance to dapsone when used for leprosy used for meningococcal prophylaxis in contacts of childeren with H. influenza type B |
Rifampin
|
|
True or False: Goodpasture's syndrome is a granulomatous condition that can cause interstitial lung disease.
|
False; Goodpasture's is not a granulomatous disease
|
|
What nongranulomatous disease that commonly affects the renal and pulmonary systems can cause interstitial lung disease?
|
Goodpasture's syndrome
|
|
Idiopathic _____ _____ can cause interstitial lung disease.
|
Pulmonary fibrosis
|
|
What is another name for eosinophilic granuloma?
|
Histiocytosis X = Langerhan's cell histiocytosis= Hans-Schuller Christian disease= Letterer-Siwe disease
|
|
Name three drugs that can cause interstitial lung disease.
|
Bleomycin, busulfan, and amiodarone
|
|
What processes cause restrictive lung disease due to poor muscular effort?
|
Polio and mysathenia gravis
|
|
What processes cause restrictive lung disease due to poor structural apparatus?
|
Scoliosis and morbid obesity
|
|
What processes cause restrictive lung disease due to interstitial lung pathology?
|
Acute respiratory distress syndrome, neonatal respiratory distress syndrome, pneumoconioses, sarcoidosis, idiopathic pulmonary fibrosis, Goodpasture's syndrome, Wegener's granulomatosis, eosinophil granuloma, and certain drug toxicities
|
|
In neonatal respiratory distress syndrome, there is a deficiency of what chemical?
|
Surfactant
|
|
In neonatal respiratory distress syndrome, a surfactant deficiency leads to an increase in what?
|
Surface tension
|
|
The increased surface tension of neonatal respiratory distress syndrome results in _____ (alveolar/bronchial) ______ (collapse/hyperinflation).
|
Alveolar collapse
|
|
What cells make surfactant?
|
Type II pneumocytes
|
|
Surfactant is made most abundantly during which period of neonatal gestation?
|
After the 35th week
|
|
What ratio is used as a measure of lung maturity in neonates?
|
The lecithin-to-sphingomyelin ratio
|
|
The lecithin-to-sphingomyelin ratio within what to assess lung maturity?
|
amniotic fluid
|
|
In neonatal respiratory distress syndrome, the lecithin-to-sphingomyelin ratio is usually within what range?
|
<1.5
|
|
What is the full chemical name for surfactant?
|
Dipalmitoyl phosphatidylcholine
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Medical treatment for neonatal respiratory distress syndrome includes what treatment for the mother before birth?
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Maternal steroids
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What vascular pathology is associated with persistently low oxygen tension due to neonatal respiratory distress syndrome?
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Patent ductus arteriosus
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What are three risk factors for neonatal respiratory distress syndrome?
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Prematurity, maternal diabetes (due to elevated insulin), and cesarean delivery (due to decreased release of fetal glucocorticoids)
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How can neonates be treated for RDS after birth?
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With artificial surfactant
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In acute respiratory distress syndrome, acute alveolar damage leads to a(n) _____ (decrease/increase) in alveolar capillary permeability.
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Increase
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In acute respiratory distress syndrome, an increase in alveolar capillary permeability leads to what?
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Fluid leakage into alveoli
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In acute respiratory distress syndrome, capillary leakage causes a protein-rich fluid to leak into the alveolus. What does this form?
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A hyaline membrane on the inside of the alveolus that impedes gas exchange
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In acute respiratory distress syndrome, what initial damage leads to increased capillary permeability?
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Damage to alveolar walls by substances secreted from neutrophils
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Name seven possible causes of acute respiratory distress syndrome.
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Trauma, sepsis, shock, gastric aspiration, acute pancreatitis, amniotic fluid embolism, uremia
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What obstetric complication can result in adult respiratory distress syndrome?
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Amniotic fluid embolism
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True or False: Renal failure can result in adult respiratory distress syndrome.
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True-- uremia is one of the causes of ARDS
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True or False: Unless aspiration of gastric contents occurs in an unconscious individual, trauma does not lead to adult respiratory distress syndrome.
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False; trauma may be an independent factor leading to ARDS
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True or False: Aspiration of gastric contents may lead to pneumonia, but is not a cause of adult respiratory distress syndrome.
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False; aspiration may lead to pneumonia, as well as ARDS
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A chronic alcoholic suffering from acute pancreatitis is experiencing difficulty breathing and oxygen desaturation. From what pulmonary complication of acute pancreatitis may she be suffering?
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Acute respiratory distress syndrome
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Name three molecular mechanisms that contribute to the initial damage to the alveoli in acute respiratory distress syndrome.
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Neutrophilic toxins, activation of the coagulation cascade, and oxygen-derived free radicals
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