Phys Final Review

hypoventilation

right to left

cardiac output

hypoxemia: low arterial PO2 to tissues

→ _______

→ _______ shunt

→ low _______

→ anemia, carbon monoxide, cyanide

hypoxia

low tissue O2 delivery

hypoxemia

low blood O2

COPD

abnormal chronic inflammation causing structural airway & vascular changes

• expiratory flow

• Gas exchange

• Hyperinflation

COPD

• Decreased ________

• Airway obstruction

• ______ abnormalities

• _______ (can decrease inhalation volume)

productive

cyanosis

chronic bronchitis

• ______ cough >3 months

• _____ (blue color)

• Cor -pulmonae

• peripheral edema

• Wheezes

emphysema

enlargement of air spaces with loss of elasticity

• elastic recoil

• compliance

• perfusion

emphysema

• loss of _______ (difficulty exhaling)

• ________ increases due to hyperinflation

• thin

• mínimal Cough

• pink puffer

• _______ is NORMAL

pulmonary fibrosis

chronic epithelial damage to lung tissue → inflammation, fibroblast proliferation, & scarring

• compliance

• diffusion capacity

• nonproductive

pulmonary fibrosis

• decrease ______

• decrease in ________

• idiopathic

• progressive dyspnea

• _______ cough

• fatigue

• hypoxia

• shrinking of lung lobes

• honeycombing

tuberculosis

granulomas, necrosis, cavity formation

• inhalation of droplets

• middle/lower

• upper

• upper

Tuberculosis

• caseous necrosis

• transmitted by ________

• primary TB: occurs in ______ lung

• secondary TB: occurs in _____ lobes

• HIV, >65, IV drug users, crowded settings

• reactivation TB: _____ lobes common

low (<0.8)

normal OR increased

FEV1/FVC

• obstructive disease: ____

• restrictive disease: _____

increase (trapped air)

decreased (difficulty getting air in) and poor diffusion

lung volumes

• obstructive disease: _____

• restrictive disease: ______ and _______

acute bronchitis

short term respiratory inflammation lasting 2-5 weeks

virus

upper respiratory infection

dry; progressive

acute bronchitis

• usually caused by ____

• begins as ________

• begin with ____ cough; then progresses to ______

asthma

inflammation and increased reactivity of airway smooth muscle causing bronchoconstriction and airflow resistance

beta-2; beta-2

non-productive

asthma

• use _______ agonist to stimulate ______ receptors to bronchodilate

• _________ cough

bronchiectasis

irreversible destruction and dilation of airways, specifically the bronchi and bronchioles

bilateral lower lung lobes

sputum

bronchiectasis

• primarily impacts the __________ lobes

• large amount of _____

• finger clubbing

atelectasis

complete/partial collapse of normally expanded and aerated lung tissue at any structural level

intra-alveolar

ventilating; perfusion

gas exchange

atelectasis

• loss of _______ pressure and surfactant

• person isn’t _____ but _____ remains the same

• decrease in ______ due to collapsed alveoli

• common post-op complication

pneumonia

acute lung injury where inflammation from an organism affects lung parenchyma

pneumonia

• alveoli fill with fluid and inflammatory cells... decrease in O2 diffusion

• upper respiratory infection often precedes pneumonia

• pleuritic chest pain

• asymptomatic in elderly

• aspiration pneumonia = R upper lung most affected

sarcoidosis

• Non-caseating granulomas

• Multi-organ disease

• scaly/rashy appearance

Pneumoconiosis

• Inhaled particles → fibrosis

• Examples:

  • Silicosis

  • Asbestosis

pneumothorax

Air in pleural space → lung collapse

• loss of negative pressure between layers

pleural effusion

Fluid in pleural space → compression of lung

• Hypoventilation

• V/Q mismatch

• Right-to-left

Causes of Hypoxemia

• High altitude

• _______

• Diffusion defect

• ______

• ______ shunt

• Hypoxemia

• cardiac output

Causes of Hypoxia

• ______

• ↓ ______

• Anemia

perfusion; ventilaiton

O₂, CO₂

Shunt (Low V/Q)

• _____ without _____

• ↓ ____ ↑ _____

• Example: airway obstruction

ventilation; perfusion

Dead Space (High V/Q)

• ____ without ____

• Example: pulmonary embolism

stretch, pH

CNS

smooth

secretion

Afferent/Efferent Control of Motility

• Afferent (sensory):

  • Detect ____, ____

  • Send info to ____

• Efferent (motor):

  • Control _____ muscle contraction

  • Control _____

CN IX & X

pharynx/esophagus

Key Reflex Example: Swallowing

• Afferent: CN ___ & ___ → medulla

• Efferent: medulla → _______

HCO3-

carbs

proteins

fats

Pancreatic Secretions

• _______ → neutralizes acid

• Enzymes:

  • Amylase → ___

  • Proteases → ___

  • Lipase → ___

nose

pharynx

larynx

Respiratory Tracts

• Upper: what 3 parts?

Trachea → bronchi → bronchioles → alveoli

Respiratory Tracts

• Lower: ____ → ____ → _____ → _____

conducting zone

lung zone

• Air transport, warming, humidifying

• Includes bronchi → terminal bronchioles

respiratory zone

lung zone

• Gas exchange

• Includes alveoli (Type I & II pneumocytes)

dead space

volume of the airways and lungs that doesn’t partake in gas exchange

physiologic dead space

total volume of lungs that doesn’t partake in gas exchange (anatomic and functional) and includes regions of the lungs that are ventilated but no gas exchange occurs (damaged)

• Diaphragm

• Thoracic

• Pressure

Inspiration

• _____ contracts

• _____ volume ↑

• _____ ↓ → air flows in

passive

Expiration

• ____ (elastic recoil)

• Forced uses:

  • Abdominals

  • Internal intercostals

• abdominal; ribs

• volume

• pressure

diaphragm (contracted)

• _____ pushed down & ____ lift up when contracted

• increase in intrathoracic ___

• decrease in intrathoraric _____

inspiration

expiration

negative

alveoli

• Alveolar pressure:

  • ↓ during ___

  • ↑ during ____

• Intrapleural pressure:

  • Always ____

• Transmural pressure:

  • Keeps ___ open

compliance

• ↑ compliance = easier expansion

Ease of lung expansion

• affinity

• unloading

• CO₂

• pH

• temperature

Right shift (↓ _____, ↑ ____)

• ↑ ____

• ↓ ___ (Bohr effect)

• ↑ ______

affinity; unloading

metabolic activity

hypoventilation

lungs

tissues

• Left shift (↑ ____, ↓ ____)

  • decrease in _____

  • increase in pH

  • ______

  • ____ = loading

  • ____ = unloading

apex

base

Regional differences

• ____: high V/Q

• ____: low V/Q

• bronchodilation

• bronchoconstriction

Autonomic Nervous System &. Airway Resistance

• sympathetic adrenergic (B2) = ______

• parasympathetic cholinergic (M) = _______

intrapleural space

negative pressure of ________ generated by the opposing forces maintains the lungs open & chest wall from springing out

central chemoreceptors

Keep arterial CO2 in normal range

Respond directly to changes in ph & indirectly to changes in arterial PCO2

peripheral chemoreceptors

carotid & aortic bodies

respond to changes in PaO2, PaCO2, & arterial pH

causes increase in RR under...

→ PO2 below <60 mmlg

→ increase in arterial CO2 pH

→ decrease in arterial pH

innate

Immunity type

• Present before exposure

• Non-specific

• Fast response

recognition

amplification

effector

termination

memory

phases of immune response in order

recognition

phases of immune response

• innate/adaptive immunity

amplification

phases of immune response

• proliferation

effector

phases of immune response

• removal of antigens

termination

phases of immune response

• dampening

memory

phases of immune response

• long lived T & B lymphocytes

type IV

Hypersensitivity Type

cytotoxic T cells kill & destroy target cells

lymphokine cells activate macrophages which attached to target cells, release cytolytic enzymes = tissue destruction

hypothalamus

• Releases releasing hormones (TRH, CRH, GHRH)

• Controls pituitary

anterior pituitary

• TSH → thyroid

• ACTH → adrenal cortex

• GH → growth

• Prolactin → milk production

• FSH/LH → reproduction

posterior pituitary

• ADH → ↑ water reabsorption

• Oxytocin → uterine contraction & milk ejection

thyroid

• T3/T4 → ↑ metabolism

• Calcitonin → ↓ Ca²⁺ (minor role)

Parathyroid

PTH → ↑ Ca²⁺

• Bone resorption

• Kidney reabsorption

• GI absorption (via vitamin D)

adrenal cortex

• Cortisol → stress, ↑ glucose

• Aldosterone → ↑ Na⁺, ↓ K⁺

• Androgens → sex characteristics

adrenal medulla

• Epinephrine/Norepinephrine

• Fight-or-flight response

pancreas

• Insulin → ↓ blood glucose

• Glucagon → ↑ blood glucose

• Somatostatin → inhibits both

kidney

• Erythropoietin (RBC production)

• Renin (BP regulation)

insulin (fed state)

• ↓ blood glucose

• ↑ storage (glycogen, fat, protein)

glucagon (fasting state)

• ↑ blood glucose

• ↑ glycogenolysis & gluconeogenesis

• ↑ lipolysis

somatostatin

• “Brake system”

• ↓ insulin & glucagon

GH

GH

Pituitary Disorders

Hyperpituitarism

• ____ excess → gigantism (kids), acromegaly (adults)

Hypopituitarism

• ____ deficiency → dwarfism

SIADH

• Too much ADH

• Water retention → hyponatremia

Diabetes Insipidus

• Too little ADH

• Excess urination + dehydration

hyperthyroidism

• ↑ metabolism

• Weight loss, heat intolerance, tachycardia

• Graves disease = most common

hypothyroidism

• ↓ metabolism

• Weight gain, cold intolerance, fatigue

• Myxedema (severe form)

Hyperparathyroidism

endocrine pathology

• ↑ Ca²⁺ → bone breakdown

• Kidney stones

• Fractures

Hypoparathyroidism

• ↓ Ca²⁺ → tetany

• Muscle spasms

addison’s disease

Adrenal disorder

• LOW cortisol

• Hypotension

• Weight loss

• Hyperkalemia

cushing’s disease

Adrenal disorder

• Moon face, buffalo hump

• Hyperglycemia

• Muscle wasting

• high cortisol

sertoli

leydig

Gonadal Sex

Male (Testes)

• _____ cells → antimüllerian hormone

• _____ cells → testosterone

theca

granulosa

Gonadal Sex

Female (Ovaries)

• _____ cells → progesterone + androstenedione

• _____ cells → estradiol

sertoli cells

Spermatogenesis is supported by ______ cells

pregnancy

implantation

uterine

Progesterone

• Maintains ______

• Prepares uterus for _______

• Decreases _____ contractions

• Thickens cervical mucus

estrogen

FSH

FSH/LH

Follicular Phase (Day 0–14)

• Dominant hormone: ______

• Events:

  • Follicle development (____ hormone)

  • Endometrial growth

• Negative feedback → ↓ ___/___

LH

estrogen

Ovulation (Day 14)

• Trigger: ___ surge

• Caused by:

  • High ______ → positive feedback

progesterone

Progesterone + estrogen

Luteal Phase (Day 14–28)

• Dominant hormone: _______

• Corpus luteum produces:

  • ______ and _______

• Prepares uterus for implantation

progesterone + estrogen

Menses

• ↓ ______ and ______

• Shedding of endometrium

• FSH/LH

• testes

Fetal Development

• GnRH → _____/____ begin early

• SRY → _____ develop first

FSH & LH

Puberty

• Pulsatile GnRH → ↑ ____ and _____

• Leads to:

  • Testosterone (male)

  • Estrogen (female)

• Secondary sex characteristics develop

estrogen

FSH & LH

Aging (Menopause)

• ↓ ____

• ↑ ____ and ____ (loss of feedback)

type 1

hypersensitivity type

• Fast (minutes)

• Mast cell degranulation → histamine

type II

hypersensitivity type

• Antibodies attack cells directly

• Myasthenia gravis

• Graves disease

• Hemolytic anemia

type III

hypersensitivity type

• Antigen + antibody complexes deposit in tissues

• lupus