1
Q
muscle of inspiration (use when)
A
- diaphragm (always)
2. External and accessory muscles (exercise and respiratory distress)
2
Q
muscle of expiration
A
expiration is passive. Muscles uses during exercise or airway resistance (eg. asthma)
- abdominal muscles
- internal intercostal muscles
3
Q
internal vs external intercostal muscles according to function
A
external intercostal –> inspiration
internal intercostal –> expiration
4
Q
Compliance (C) equation
A
C=V/P
5
Q
Lung - hysteresis?
A
lung inflation (inspiration) curve follows a different curve than the lung deflation (expiration) curve due to need to overcome surface tension forces in inflation
6
Q
surfactant reduces surface tension by … (mechanism)
A
disrupting the intermolecular forces between liquid molecules
7
Q
the site in respiratory system with the highest resistance
A
medium sized bronchi
8
Q
changes in airway resistance - mechanism (explain)
A
by alterining the radius (SMCs contraction or relaxation)
- Paraysmpathetic –> constriction –> increased R
- Sympathetic –> relaxation –> decreased R
9
Q
resistance of lung during deep-see dive
A
both air density and resistance to airflow are increased (increased viscosity)
10
Q
resistance of lung - decreased viscosity during
A
breathing a low-density gas (such as helium)
11
Q
lung - physiologic shunt (definition, results)
A
appriximately 2% of the systemic cardiac cardiac output bypasses the pulmonary circulation – PO2 of arterial blood slightly lower than the alveolar air
12
Q
nomal values of PO2 and PCO2 in venous blood
A
PO2 –> 40
PCO2 –> 46
13
Q
LUNG - for perfusion-limited process, diffusion of the gas can be increased only if
A
blood flow increases
14
Q
P02 40 (venous blood) - Hb saturation
A
75%
15
Q
PO2 25 - Hb saturation
A
50%
16
Q
Hb saturation - the curve is almost half when PO2 is …. (purpose)
A
60 - 100 mmHg
humans can tolerate changes in atmospheric pressure
17
Q
hemoglobin curve - P50?
A
partial pressure of PO2 in which Hb saturation is 50%
18
Q
deohyhemoglobin
A
Hb + H+
19
Q
Carboxyhemoglobin
A
Hb + CO
20
Q
distribution of pulmonary blood flow - supine vs standing
A
supine –> uniform throughout lung
standing –> effect of gravity –> highest at the base
21
Q
distribution of pulmonary blood flow - in Apex the alveolar pressure may compress the cappillaries and reduce blood flow - situation
A
if arterial blood pressure is decreased as a result of hemorrhage or if alveolar pressure is incresaed because of positive ventilation
22
Q
The magnitude of a right-to-left shunt can be estimated by
A
having the patient breath 100% 02 and measuring the degree of dilution of oxygenated arterial blood by nonoxygenated shunted (venous) blood
23
Q
LUNGS - normal V/Q is approximately
A
0.8
24
Q
pO2 and pCO2 - apex vs base
A
pO2 is highest and pCO2 is lower at the apex because gas exchange is more efficient
25
Medullary respiratory center is located in
reticular formation:
dorsal --> inspiration
ventral --> expiration `
26
ventral respiratory group - states of activation
not active during normal (passive expiration)
| is activated during active process
27
dorsal respiratory groups - input and output
input --> via vagus (peripheral chemoreceptors and mechanoreceptors of lung) and glossopharyngeal (peripheral chemoreceptors)
output --> phrenic nerve to diaphragm
28
Apneustic center - location and function
lower pon
| stimulate inspiration, producing deep and prolonged inspiratory gasp (apneusis)
29
Pneumontaxic center - location and function
upper pons
| inhibits inspiration --> regulates insiratory volume and respiratory rate
30
Cerebral cortex - breathing
can be under voluntary control
31
Hypoventilation (breath holding) is limited by
resulting inncrease in PCO2 and decrease PO2
32
peripheral vs central chemoreceptors according to location
peripheral --> carotid and aortic bodies
| central medulla
33
central chemoreceptros - inreased breathing rate if
```
low ph (CO2, not H+)
high PCO2
```
34
peripheral chemoreceptros - inreased breathing rate if
```
low ph (H+, independently to pH)
high PCO2
low PO2 (under 60)
```
35
peripheral vs central chemoreceptors according to O2
detected only by peripheral
36
Beside chemoreceptros and central control, other types of receptors that control breathing
1. Lung stretch receptor
2. irritant receptors
3. J (juxtacapillary receprors)
4. Joint and muscles receptors
37
control breathing - Lung stretch receptor
when Lung strectch receptors (on SMC of the airways) are stimulated by distention --> decresea in RR (Hering-Breuer reflux)
38
Hering-Breuer reflux?
when Lung strectch receptors (on SMC of the airways) are stimulated by distention --> decresea in RR
39
control breathing - irritant receptors
located vetweein airway epithelial cells --> stimulated by noxious substance (eg. dust and polle)
40
control breathing - J (juxtacapillary receprors)
located in alveolar walls (close to capillaries)
| engorgement of pulmon capillaries (eg. LHF) --> stimulates J receptos --> rapid, shallow breathing
41
control breathing - Joint and muscles receptors
movement of limbs --> activation --> early stimulation of breathing during exercise
42
arterial ph during exercise
- not change during moderate exercise
| - decrease during strenuous --> lactic acidosis
43
3 lung situations associated with clubbing
1. Idiopathic pulmonary fibrosis
2. Brochiectasia
3. Adenocarcinoma
44
causes of increased vital capacity
acromegaly
45
normal physiologic dead space
150
46
lung metastasis - MC from
| MC singe area of lung tumor metastasis
1. colon, prostate, breast bladder
| 2. brain
47
mesothelioma - histology
papillary bodies
| carletin and cytokeratin (+)
48
lung consolidation - breath sounds
bronchial breath + late inspiratory crackles
49
symptoms of glucagonoma
1. depression
2. dermatitis
3. DVT
4. diabetes
50
head + neck Ca - risk factros
1. tobacco
2. alcohol
3. HPV-16 (oropharyngeal)
4. EBV (nasopharyngeal)
51
H. infl - type of pneumonia
brobronchopneumonia
52
structrures that perforate diaphragm
IVC at T8
esophagus + vagus at T10
azygus, aorta, thoracic duct at T12
53
Lung - collapsing pressure - equation
(2xsurface tension) / radius
54
foam stability test
Mix amniotic fluid with 95% ethanol
| if buccles --> (+)
55
lung + chest wall - decreased + increased complaiance situations
decreased - consolidation, fibrosis
| increased - COPD, age
56
iron status Hb
Ferrous --> Fe2+
| Ferric --> Fe3+
57
O2 content (equation)
Hb x 1.34 x saturation = (0.03 x PaO2)
58
Hypoventialtion causes hypoxemia - prove it
increased PaCO2 (PAO2 = PIO2 - PaCO2/R)
59
Bohr vs Haldone effect according to location
Borh --> peripheral
| Haldone --> lungs
60
Chronic bronchitis vs emphysema according to PCO2 + PO2
chornic borchitis --> increased (retention), hypoxemia
| emphysema --> normal CO2, mild hypoxemia
61
Ferruginus bodies - visualised with
prussian blue
62
ARDS - characteristics
1. no HF
2. acute resp failure
3. bilateral lung opacities
4. decreased PaO2/FiO2
63
central sleep apnea - due to
CNS
opioids
HF
64
aspirin induced asthma - treatment
modelukast, zafirlucast
65
flunisolide
inhaled glucocorticoids - prophylactic treatment for astha
66
Desquamative interstitial pneumonia? (treatment)
type of restrictive lung disease (association with smoking)
| treat with steroids
67
pancoast tumor vs SVC syndrome
pancoast tumor must cause lung shoulder pain (and maybe Horner) --> it also can cause SVC syndrome
if SVC syndrome alone --> mediastinal mass (mcc by lung ca, followed by non-Hodgkin)
68
reactivation of TB - why upper lungs
1. higher O2
| 2. decreased lymphatic flow
69
MCC of 1ry spontaneous pneumothorax
smoking
| also taller thin males are commonly affected
70
most common presenting symptom of Pancoast tumor
shoulder pain radiating toward the axila + scapula (due to involvement of lower branchial plexus
71
bronchiolitis obliterans - pulmonary test
drop of FEV1/FVC ratio
72
lung tumor with neural cell adhension molecule (and aka
small cell
| NCAM (CD56)
73
Risk of 2nd hand smoke expouse
1. prematurity, low birth weight (pregnancy)
2. sudden infnat death syndrome (pregnancy or infants)
3. middle ear disease (children)
4. Asthma
5. Respiratory tract infections
74
major clinical manifestation of asbestos (and when)
1. pleural plaques (parietal pleura) - dense circumscribed areas of dense collagen that become calcified --> 15 years after initial exposure
2. Abestosis - diffuse pulmoary fibrosis + asbestos bodies (15-20 years after)
3. Brochogenic carcinoma (synergistic with smoking) --> nonsmoking with asbestos is 6 fold, smoking + asbestos 60
4. Mesothelioma (mor specific to HEAVY asbestos exposrue)
75
PE - autopsy
wedge-shaped hemorrhagic
76
Pulmonary alveolra proteinosis
very grandual worsening of dyspnea + PRODUCTIVE cough
histology: bilateral patchy pulmonary opacification due to intraalveolar accumulation of amorphous protein + phospholipid material (constituents of surfactant)
77
CREST in lung
intimal thickening of pulmonary arterioles --> cor pulmonale
78
Stages of lobar pneumonia
1. Congestion (first 24h)
2. Red hepatization (day 2-3)
3. Gray hepatization (4-6h)
4. Resolution
79
lung hamartomas - manifestation / appearance
asymptomatic, peripherally located, coin lesion, age 50-60, composed of disorganized CARTILAGE, fibrous + adipose tissue
80
Large cell carcinoma - paraneoplastic
Gynecomastia. Ga;actorrhea
81
bronchorrhea?
watery sputum due to mucinous production
82
Sarcoidosis - steps
1. bilateral hilar lymphadeopathy
2. bilateral hilar lymphadeopathy with pulmonary inflitrates (esp upper)
3. disappearance of hilar lymphadeonpathy
4. lung fibrosis
83
except the classic triad, fat embolism also causes
1. anemia (increased RBC aggregation + destruction, as well as possible pulm hemorrhage
2. thrmombocytopenia
84
increases the risk of Goopdasture
exposure to Hyrdoxycarbon solvent + cigaret
85
long term exposure to nitroglycerine can cause
cardiac arrest
86
alpha 1 antitrypsin - diagnosis / age of live disease / age of lung disease
diagnosis: measurement of serum ATT level --> followed by confirmatory genetic test
age of liver: first 2 decades
age of lung: 51 in nonsmokers, 36 in smokers
87
ribs are divided to
1. true (1-7)
2. false (8-10)
3. Floating (11-12)
88
Sternal angle as a landmark
at T4-T5:
1. trachea bifurcates
2. Azygus in SVC
3. begining of aortic arch
89
fracture of the rib comonly occur at
anterior angle of the rib
90
sensory innervation of diaphragm
1. phrenic nerve (most)
| 2. intercostal nerves (periphery of diaphragm)
91
external vs internal intercostal muscles
external --> elevates true + false ribs --> increase transverse diameter --> inspiration
internal --> expiration
92
other accessory muscles of inspiration (beside external intercostal)
1. Ssternocleidomastoid
2. scalene
3. pectoralis major and mino
(attache the ribs)
93
piriform recesses?
small cavities on either side of laryngeal orifice
bounded laterally by thyroid cartilage + thyrohyoid membrane
medially by aryepiglottic folds
contain the superficially the internal laryngeal nerve (branch of the superior laryngeal nerve) so it is susceptible to injury if foreign bodies lodged their
94
1. middle meningeal artery is a branch of
2. facial artery is a branch of
3. occipital artery is a branch of
4. opthalmic artery is branch of
5. sphenopalatine artery is a branch of
1. maxillary
2. external carotid
3. facial artery
4. internal carotid
5. maxillary
95
nerve that increases diameter of oropharynx (eg. in sleep apnea)
hypoglossal
96
what is carina?
cartilaginous ridge within trachea that separates the opening of the right and left mainstem bronchi --> occurs at stenal angle (T4/5)
97
superior mediastinum contains
1. thymus gland (anterior inferior in children)
2. trachea
3. esophagus (intended in left by aorta and anteriorly by left main bronchus)
4. thoracic duct (posterior the esophagus)
6. aortic arch (and branches)
7. SVC (and left/right brachiocephalic veins)
8. vagus
9. left recurrent (NOT THE RIGHT)
10. phrenic nerve
98
anter inferior mediastinum contains
1. thymus in children
2. smaller vessels
NO NERVES
99
middle inferior mediastinum
1. heart (and pericardium and vessels)
2. prhenic nerves
3. pericardiophrenic nerves
100
posterior mediastinum contains
1. esophagus
2. descending aorta
3. thoracic duct
4. azygus + hemiazygus
101
lung - lymph nods
each lung to bronchopulmonary nodes at the hilus
right lung + inf lobe of left--> right lyphatic duct
left lung --> thoracic duct
102
bronchopulmonary segment - supplied by
each is supplied by a tertary bronchus + 2 arteries (bronchial + pulmonary) all run in the center of the segment
veins + lymphatics tun together along the edge of the segment
103
horizontal fissure of right lobe - location
4th rib anterior
104
to anesthisize intercostal nerve -->
insert into superior part on interspace
105
Thoracentisis - pass through
skin --> superficial fascia --> serratus anterior --> 3 layers of intercostal muscles --> parietal pleura
106
inferior extend of visceral pleura and lung
midclavicular line --> 6th rib
midaxillary line --> 8th rib
paravertebral line --> 10th rib
107
inferior extend of parietal pleura
midclavicular line --> 8th rib
midaxillary line --> 10th rib
paravertebral line --> 12th rib
108
intercostal nerves + vessels course
superior part of each intercostal space --> VAN (ΦΑΝ)
| --> vein is superior and nerve inferior
109
pleural innervation
1. visceral --> sensory nerves that course with autonomic (insensitive to pain)
2. costal parietal --> intercostal nerves
mediastinal parieta + most diaphragmatic --> phernic nerve (sensitive to pain)
respiratory
flashcards
Decks in class (27)
# Cards
-
Asthma and drugs68
-
Lung volumes28
-
Lung cancer84
-
lung - physical findings25
-
Pleural effusions - pneumothorax26
-
Rhinosinusitis - epistaxis - DVT/PE39
-
Pneumonia - Lung abscess33
-
Diaphragm structures - Lung relations27
-
respiratory tree - pneumocytes44
-
Lung and chest wall20
-
hemoglobin67
-
alveolar gas equation/oxygen deprivation/ V/Q29
-
CO2 transport22
-
drugs40
-
Obstructive lung disease70
-
Pneumoconiases42
-
pulmonary hypertension and drugs40
-
Respiratory distress syndrome (Acute and Neonatal)22
-
sleep apnea20
-
Restrictive lung disease25
-
Pulmonary circulation18
-
embryology25
-
others109
-
other 218
-
FA 1139
-
UW 181
-
UW 255
