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pulm Flashcards

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1
Q

stridor

A

high-pitched sound during inspiration secondary to upper airway obstruction or narrowing in upper airway (at and above the larynx)

Ex:
croup

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2
Q

barrel chest

A

causes include COPD, aging
(with thoracic kyphosis)

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3
Q

pectus excavatum

A

funnel-chest

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4
Q

pectus carinatum

A

pigeon-chest

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5
Q

flail chest

A

trauma, “sucking” sound

medical emergency

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6
Q

life threatening

A

flail chest

three or more contiguous rib fractures in at least two places with detachment from the cage

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7
Q

paradoxical breathing

A

a breathing pattern that’s the opposite of
normal breathing

It occurs when the chest wall moves in during inhalation and out during exhalation, while the abdomen moves in during exhalation and out during inhalation

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8
Q

crackles or rales

A

high-pitched, discontinuous sounds (pulmonary edema)

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9
Q

wheezes

A

high-pitched, musical sounds (bronchospasm)

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10
Q

rhonchi

A

snoring or gurgling sounds (COPD, pneumonia)

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11
Q

friction rubs

A

rough, grating, scratching sounds (Pleurisy, TB, pneumonia, and lung CA)

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12
Q

respiratory system

A

to provide an adequate oxygen (O2) supply to meet the energy production requirements of the body and maintain a suitable acid-base status by removing carbon dioxide (CO2) from the body

functions in olfaction and speech

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13
Q

ventilation

A

the process of air movement into the lungs, is a carefully controlled modality with a wide range of response that enables the
markers of gas exchange adequacy (PaO2, PaCO2, and pH) to be kept within a relatively small physiologic range (breathing)

at rest in most individuals and requires only the active inspiratory muscles

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14
Q

ABG

A

Measure of the oxygen, carbon dioxide, and pH (acid-base balance) in
your blood

Measures how well the lungs are able to move O2 into your blood and
remove CO2 from your blood

Ex:
1. Pulmonology: respiratory failure
2. Severe illness (cardiac, liver, renal failures)
3. Ventilated patients
4. Emergency care
5. Anesthesiology
6. Diabetic patients

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15
Q

respiratory acidosis

A

respiratory depression (drugs, CNS trauma)

COPD

pneumonia

asthma

HF

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16
Q

respiratory alkalosis

A

hyperventilation (emotions, pain)

PE

anxiety

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17
Q

metabolic acidosis

A

diabetes
shock
renal failure

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18
Q

metabolic alkalosis

A

sodium bicarbonate
overdose
prolonged vomiting
NG drainage

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19
Q

acidosis in the lungs

A

means the body retains CO2 (retains an acid)

Cause: any process that decreases the ability of the lungs to exchange CO2 for O2

may result from depressed respiratory rate AND tachypnea with poor ventilation (RR of 80)

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20
Q

alkalosis in lungs

A

the body eliminates or “blows off” CO2 (loses an acid)

Cause: any process which increases respiratory rate

must differentiate hyperventilation (true exchange of gases) from tachypnea

Tachypnea: rapid shallow breathing from a lack of oxygen or too much carbon dioxide (poor exchange rate)

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21
Q

acidosis pH

A

<7.35

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22
Q

alkalosis pH

A

> 7.45

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23
Q

CO2 (acidosis)

A

if pH <7.35
>45 is high= respiratory acidosis
normal= metabolic-> check HCO3-

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24
Q

CO2 (alkalosis)

A

if pH >7.45
<35 is low= respiratory alkalosis
normal= metabolic-> check HCO3-

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25
compensation
CO2 increase and HCO-3 increase CO2 decrease and HCO-3 decrease pH 7.35 – 7.45 fully compensated pH <7.35 or >7.45 partially compensated
26
no compensation
CO2 increase and HCO-3 decrease CO2 decrease and HCO-3 increase
27
external expiration
usually passive and is secondary to the respiratory system returning to its resting state gas exchange of O2 and CO2 between lungs and blood Relaxing diaphragm moves up Inspiratory muscles relax, thoracic cavity volume decreases, and lungs recoil Volume decrease causes intrapulmonary pressure to increase moving air out of the lungs
28
internal respiration
circulatory system gas exchange of O2 and CO2 between systemic blood and tissues
29
upper respiratory
Nose and nasal cavity Paranasal sinuses Pharynx = throat
30
lower respiratory
Larynx = voice box Trachea = windpipe Bronchi and branches Lungs and alveoli
31
smoking
destroys cilia-> cough reason smokers with respiratory congestion should avoid medications that inhibit cough reflex
32
COPD
emphysema chronic bronchitis
33
tracheal obstrcution
life threatening many people have suffocated after choking on a piece of food that suddenly closed off their trachea
34
heimlich maneuver
procedure in which air in victim’s lungs is used to “pop out,” or expel, an obstructing piece of food
35
conduction zone passages
move O2 and CO2
36
exchange zone
gas exchange simple squamous epithelium
37
alveoli and respiratory membrane
where the respiratory system meets circulatory system
38
inspiration
gases flow into lungs active process inspiratory muscles (diaphragm and external intercostals muscles contracting)
39
volume changes
in the thoracic cavity leads to pressure changes in the lungs intrathoracic volume
40
pressure changes
in the lungs lead to flow of gases to equalize pressure intrapulmonary pressure pressure changes are relative to atmospheric pressure (air in the room = 760mm Hg)
41
diaphragm
flattened when inhaling (volume increases and pressure decreases) domed upwards when exhaling (volume decreased and pressure increases)
42
intercostal muscles
when external intercostals contract, rib cage is lifted up and out results in increase in thoracic volume this also results in a decrease pressure in the lungs
43
forced expiration
an active process that uses oblique and transverse abdominal muscles, as well as internal intercostal muscles
44
boyle's law
inverse relationship between the pressure and volume of a gas p=k/v In a gas, as the volume of a cylinder increases, the pressure of the gas decreases Also, as the volume of a cylinder decreases, the pressure of the gas increases
45
spirometer
original, cumbersome clinical tool used to measure patient’s respiratory volumes Electronic measuring devices used today
46
tidal volume
amount of air moved into and out of lung with each quiet breath Averages ~500ml
47
inspiratory reserve volume
amount of air that can be inspired forcibly beyond the tidal volume (2100–3200 ml)
48
expiratory reserve volume
amount of air that can be forcibly expelled from lung (1000-1200ml)
49
residual volume
amount of air that always remains in lungs (1200ml) Needed to keep alveoli open
50
vital capacity
TV + IRV + ERV (4800ml)
51
total lung capacity
sum of all lung volumes TV+ IRV+ ERV + RV (6000ml)
52
asthma
Bronchospasm and inflammation Episodic wheezing Chronicity Hyperresponsiveness of airways to a variety of stimuli Largely reversible Considered an airway obstruction from bronchial SM contraction Immune cell infiltration include: 1. Eosinophils 2. T lymphocytes: release cytokines (IL4, 5, 13) triggers of inflammation 3. Mast cells and basophils: release histamine – inflammatory response 4. Macrophages: cells that orchestrate the inflammatory response
53
risk factors of asthma
Poor compliance (meds, environment, triggers) Upper Respiratory Infection Exposure (dust, pollen, per dander, tobacco smoke, cold air)
54
exacerbating conditions for asthma
Allergies Cough variant asthma Occupational exposures Exercise-induced asthma
55
B2 receptors
NE binds to it leads to smooth muscle relaxation and bronchodilation (or decreased airway resistance SABA(agonist) = albuterol SAMA= short acting muscarinic antagonist
56
Ach
released from parasympathetic nervous system to muscarinic receptors (m3) on bronchiole smooth muscle (key: a B2 receptor for NE is different from an m3 receptor for ACh) ACh binding to m3 contributes to bronchoconstriction and mucus secretion, acetylcholine also contributes to airway inflammation
57
concomitant treatment for asthma
B2 agonist (short acting beta agonist) (SABA), Inhaled Corticosteroids (ICS), and anticholinergic (SAMA) short acting muscarinic antagonist – m3 = muscarinic antagonist
58
proinflmmatory mediators
produced by mast cells during an asthma attack, allergy triggers, pollution, immune triggers Lead to: Bronchospasm Mucus secretion Airway edema Recruitment of eosinophils (causing bronchial hyperactivity) – and are also responsible for production of leukotrienes
59
leukotriene modulators
also called leukotriene receptor antagonists or leukotriene synthesis inhibitors, are medications that block the effect of leukotrienes or stop your body from producing them
60
methylxanthines
relatively weak bronchodilators that are administered systemically They have been used for treatment of acute exacerbations as well as for long-term control of asthma symptoms The most common methylxanthine used for asthma treatment is theophylline
61
FEV1
forced expiratory volume in 1 second – and is a measurement of how much air a person can exhale in the first second of forced exhalation It's a type of spirometry test, which is a non-invasive pulmonary function test that measures how well a person's lungs are working Normal FEV1 = 60 – 80% of FVC-> mainly 80%
62
FVC
forced vital capacity – and is a measurement of lung volume that measures the maximum amount of air a person can exhale after inhaling as deeply as possible It's a common pulmonary function test used to monitor respiratory health and differentiate between obstructive and restrictive lung diseases Normal FVC = 4800ml = 4.8L (normal adult 3.0 – 5.0L)
63
obstructive
COPD asthma emphysema chronic bronchitis flow problem FEV1/FVC= <0.8 slow deep breathes to combat air flow resistance
64
restrictive
scoliosis obesity neuromuscular disease cystic fibrosis volume problem FEV1/FVC= >0.8 fast, shallow breaths to combat elastic resistance
65
FEV1/FVC
ratio used to distinguish restrictive and obstructive disease
66
surfactant
prevent surface tension helps prevent lung collapse produced by alveolar cells
67
lung lobes
limits the spread of infection each served by its own vein and artery if diseased, can be individually removed
68
bronchopulmonary segments
10 segments of right lung 9 segments of left lung
69
lobule
smallest subdivisions of bronchiole tree visible to naked eye; hexagonal segments served by bronchioles and their branches
70
composition of lungs
mostly alveoli rest stroma and elastic CT (makes lungs elastic and spongy)
71
pulmonary circulation
pulmonary arteries and veins
72
pulmonary arteries
deliver systemic oxygen-poor blood from heart to lungs for oxygenation: Branch profusely to feed into pulmonary capillary networks
73
pulmonary veins
carry oxygenated blood from respiratory zones back to heart Low-pressure, high-volume system Lung capillary endothelium contains many enzymes that act on different substances in blood: Example: angiotensin-converting enzyme activates blood pressure hormone
74
bronchial circulation
bronchial arteries
75
bronchial arteries
provide oxygenated blood to lung tissue: Arise from aorta and enter lungs at hilum Part of systemic circulation, so are high pressure, low volume Supply all lung tissue except alveoli Bronchial veins anastomose with pulmonary veins: Pulmonary veins carry most venous blood back to heart
76
pulmonary plexus
Nerves run along bronchial tubes and blood vessels Parasympathetic (Ach) fibers cause bronchoconstriction, whereas sympathetic (NE) fibers cause bronchodilation
77
pleurae
thin, double-layered serosal membrane that divides thoracic cavity into two pleural compartments and mediastinum
78
parietal pleura
membrane on thoracic wall, superior face of diaphragm, around heart, and between lungs
79
visceral pleura
membrane on external lung surface
80
pleural fluid
Provides lubrication and surface tension that assists in expansion and recoil of lungs Pleural fluid originates from the parietal pleurae Pleural fluid is reabsorbed by the lymphatic system In a healthy person, the pleural space contains a small amount of fluid, usually around 10 to 20 ml. The balance of hydrostatic and oncotic pressure differences between the pleural space and the systemic and pulmonary circulation determines the volume of pleural fluid
81
pleural effusion
fluid buildup in the pleural space. This can be caused by a number of things, including: Increased production Decreased resorption Organ failure, such as heart, liver, or kidney failure Pulmonary embolism Lung infection Cancer
82
type 1 cell
simple squamous epithelium
83
type 2 cell
produces or releases surfactant keeps alveoli inflated
84
type 3 cell
macrophage
85
nasal vestibule
Lined with vibrissae (hairs) that filter coarse particles from inspired air
86
inhalation
nasal conchae and mucosa filter, heat, and moisten air
87
exhalation
Reclaims heat and moisture
88
intrapulmonic pressure
760 mmHg equal to atmospheric pressure
89
intrapleural pressure
756 mmHg
90
contraction/constriction of bronchial SM
allergens and Ach
91
CN X
releases Ach which binds to muscarinic receptors and causes bronchoconstriction (SAMA)
92
saddle embolism
blocked BF to pulmonary arteries due to clot being lodged in the bifurcation -> results in blocked BF to both lungs
93
transpulmonary pressure
-4 mmHg to stay inflated
94
waterlogged pulmonary edema
number one cause is HF
95
emphysema
reduced SA
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