CLIN PATH I: EXAM #2 (PULM PATHO LEC)

____________ pleura-covered lungs contained by chest wall and diaphragm (bellows)

Visceral

Inspiration is active, exhalation is ________________

passive

With inspiration, the transpulmonary pressure is ________________

negative

What maintains anatomic integrity of the lungs?

Connective tissue and surfactant

_______________: collagen and elastic structures, allows lungs to support itself and retain airway patency

A. Connective tissue

B. Surfactant

Connective tissue

_________________: reduces surface tension, allowing expansion of alveoli

A. Connective tissue

B. Surfactant

Surfactant

What would happen if there was no surfactant?

alveolar collapse (atelectasis)

Conducting airways and terminal respiratory units (__________)

acini

What kind of cells are in the proximal conducting airways?

Ciliated pseudostratified columnar epithelial

Cilia beat in unison up to pharynx to transport _______________________ out

contaminating or excess material

As airways further branch, smooth muscle and secretory glands are ______________

reduced

Smallest conducting, non respiratory airways are ___________________

bronchioles

What type of epithelium is in the bronchioles?

cuboidal epithelium (may be cilliated)

What are the final physiologic and anatomic unit of lung?

Terminal respiratory units

Walls of thin alveolar epithelial cells provide ________________

gas exchange

Lymphatic ducts travel principally in the _______________________ back to hilar and mediastinal lymph nodes before entering the left thoracic duct or right lymphatic duct.

peribronchovascular sheath

Parasympathetic fibers (muscarinic cholinergic) --> mediate ___________, pulmonary _________, and _________ secretion.

bronchoconstriction, vasodilation, mucous gland

Parasympathetic fibers (muscarinic cholinergic) --> ________________

A. Efferent

B. Afferent (Vagal)

Efferent

Sympathetic fibers --> bronchial smooth muscle _____________, pulmonary ___________, and inhibition of ________ __________ activity

relaxation, vasoconstrictionsecretory gland

Sympathetic fibers --> bronchial smooth muscle relaxation, pulmonary vasoconstriction, and inhibition of secretory gland activity

A. Efferent

B. Afferent (Vagal)

Efferent

NANC (non-adrenergic, non-cholinergic) system (ATP, NO, and peptide neurotransmitters) --> inhibitory events including _________________

bronchodilation

NANC (non-adrenergic, non-cholinergic) system (ATP, NO, and peptide neurotransmitters) --> inhibitory events including bronchodilation

A. Efferent

B. Afferent (Vagal)

Efferent

Bronchopulmonary stretch receptors --> lung inflation results in ___________________

bronchodilation and Inc HR

Bronchopulmonary stretch receptors --> lung inflation results in bronchodilation and Inc HR

A. Efferent

B. Afferent (Vagal)

Afferent (Vagal)

______________ --> proximal airways --> cough, mucus secretion and bronchoconstriction

Irritant receptors

Irritant receptors --> __________________ --> cough, mucus secretion and bronchoconstriction

proximal airways

Irritant receptors --> proximal airways --> ________________________________

cough, mucus secretion and bronchoconstriction

C fibers, or fibers from _______________________ --> respond to mechanical and chemical stimuli --> rapid shallow breathing pattern, mucus secretion, cough, and heart rate slowing with inspiration.

juxtacapillary (J) receptors

The chest wall favors being expanded

• ______________ of the lungs (ability to relate to changes in volume to changes in pressure)

Compliance

______________: inhaled and exhaled with each breath

A. Tidal Volume (TV)

B. Inspiratory Reserve Volume (IRV)

Tidal Volume (TV)

__________________: MAX amount of air INHALED ABOVE normal tidal volume

A. Tidal Volume (TV)

B. Inspiratory Reserve Volume (IRV)

Inspiratory Reserve Volume (IRV)

__________________: MAX amount of air EXHALED BELOW normal tidal volume

A. Residual Volume (RV)

B. Expiratory Reserve Volume (ERV)

Expiratory Reserve Volume (ERV)

__________________: amount of air in lungs AFTER MAX EXHALATION

A. Residual Volume (RV)

B. Expiratory Reserve Volume (ERV)

Residual Volume (RV)

________________ = IRV + TV + ERV

A. Total Lung Capacity (TLC)

B. Vital Capacity (VC)

Vital Capacity (VC)

_________________ = VC + RV (IRV + TV + ERV + RV)

A. Total Lung Capacity (TLC)

B. Vital Capacity (VC)

Total Lung Capacity (TLC)

_________________ maneuver begins with an inhalation from FRC to TLC (lasting about 1 second) followed by a forceful exhalation from TLC to RV (lasting about 5 seconds)

Forced vital capacity (FVC)

___________________: amount of gas exhaled during the first second of this maneuver

Forced expiratory volume in 1 second (FEV1)

Ratio of the FEV1 to FVC (_____________________): Normal subjects 80% of FVC in 1 second

FEV1/FVC or FEV1%

Ratio of the FEV1 to FVC (FEV1/FVC or FEV1%): Normal subjects ___________________

80% of FVC in 1 second

FEV1/FVC or FEV1% is diminished in patients with ___________ lung disease.

A. restrictive

B. obstructive

obstructive

FEV1/FVC or FEV1% is increased in patients with ______________ lung disease.

A. restrictive

B. obstructive

restrictive

In a _____________ pattern, the chest can't expand (infiltrate) --> DEC VOLUME IN, but can EXPIRE really fast!

A. restrictive

B. obstructive

restrictive

In an _____________ pattern, the VOLUME = SAME as normal, but it is slower.

A. restrictive

B. obstructive

obstructive

Two major categories of defense

1. _________________: Clearance, secretions, cell defenses, biochemical defenses

Nonspecific Physical

Two major categories of defense

2. ____________: Antibody mediated, antigen presentation to lymphocytes, cell mediated, non-lymphocyte cellular immune responses

Chemical

Oxygen in blood is either bound to hemoglobin or dissolved in the _____________.

plasma

Oxygen content in the blood depends on: ________________________

• Arterial PO² (breath in)
• Hemoglobin level (trucks/anemia)

Tissue oxygen delivery depends on: ________________________

• Oxygen content in the arterial blood
• Cardiac output (pushes the trucks!)

_____ is 20X more soluble in plasma than oxygen

CO²

The GREATER the oxygenation of hemoglobin in the capillaries, the LESS the ability to ____________

bind CO²

•2 components of breathing:

_______________________

• Elastic forces
• Resistance to airflow

Perfusion of the lung is dependent on ____________.

posture

The gravity dependent segments have the ____________________.

greatest amount of perfusion

When seated, what zone of the lung has the greatest perfusion?

Zone 3

The ratio of ventilation to perfusion is HIGHEST at the ________ & LOWEST at the __________

apex, base

Failure to match ventilation to perfusion, or _______________ is the reason for most abnormalities in O² and CO² exchange.

V/Q mismatch

Normal V (ventilation) is _______________

4L of air per minute

Normal Q (perfusion) is _________________

5L of blood per minute

Normal V/Q ratio is ____________

4/5 or 0.8

When the V/Q > 0.8, it means _____________________, a VQ mismatch

ventilation exceeds perfusion

When the V/Q < 0.8, it means _________________, therefore poor ventilation, a VQ mismatch

perfusion exceeds ventilation

What Dz may cause a LOW V/Q?

COPD, asthma

(Shunt Perfusion: Alveoli perfused but not ventilated!)

What Dz may cause a HIGH V/Q?

PE, Cardiac Arrest

(Deadspace Ventilation: Alveoli ventilated but not perfused!)

What is the main driving force in the control of breathing?

CO2

Respiratory neurons are either ________________

inspiratory or expiratory

Respiratory neurons integrated output signals the phrenic nerve (diaphragm) and spinal nerves (intercostals & abd wall) --> _______________________

spontaneous breathing w/o conscious thought

Control of Breathing

Sensory input: via the _________________

carotid bodies & the aortic bodies

Control of Breathing

Carotid bodies: Responsible for INC ventilation seen in response to ____________

hypoxia

______________: arterial pH changes affect PaCO²

Integrated responses