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What do cystic fibrosis, Kartegener's sydrome, and smoking have in common?
They are result in a decrease in mucus clearance.
- Cystic fibrosis- Cl- channel defect
- Kartegener's- dynein defect = cilia defect
- smoking - metaplasia of pseudostratified columnar epithelium
What are Clara cells and where are they located ?
Nonciliated cells that
- - secrete serous solution (~ surfactant ) (glycosaminoglycans)
- - involved in detoxification (cytochrome P450)
- - stem cells (regenerate epithelium)
- - increase with presence of pollutants
- - involved in Cl- transport channels
Located in the bronchioles
- results in Respiratory distress syndrome due to premature birth.
- covers only 5-10% of the surface area of the alveoli
- Type II pneumocytes
- - they secrete surfactant
- - serve as stem cells for Type I pneumocytes.
A 40 year old woman comes in with a dipple about 11 oclock and a mass is felt. Explain why a mass would cause a dipple in the breast.
The dipple is the result of the tumor mass pressing on the ligament of Cooper. The Cooper ligament is binded to the deep fascia and the skin of the breast. A mass can not affect the deep fascia attachment but it can pull the skin end in resulting in the dippling that is seen in this female.
A patient comes in with difficulty breathing.
- decreased movement of the right thorax
- dullness to percussion at the base of the right lung
- diminished breath sounds at the base of the right lung
- bronchial breathing in all areas of the right lung except for the base.
- decreased vocal fremitus at the base of the left lung
- friction rub at the base of the right lung
Your attending gives a needle and tells you to handle the situation immediatetly. What and where will the needle go?
This patient has a pleural effusion of the right lung.
You are going to perform a thoracocentesis but position is important because you must enter between the lung and the parietal pleura (costodiaphragmatic recess)
- Miclavicular - 7th rib
- Midaxillary - 9th rib
- Paravertebral- 11th rib
Describe the passage of lymph flow form the alveoli.
- Bronchopulmonary nodes (hilar nodes)
- tracheobronchial nodes
- bronchomediastinal nodes
- R= right lymphatic duct
- L= thoracic duct
Then to the subclavian vein
What are the two main equations to figure out total lung capacity?
FVC + RV
FRC + IV
Where is dead space located and how does this affect alveolar ventilation?
Dead space is located in the conducting zone because there is no alveolar excahnge going on.
Dead space takes away 150ml of the tidal volume from undergoing alveolar exhange in the respiratory zone for every inspiration.
What combination of Tidal volume and respiratory rate would lead to an acidotic condition?
- Low tidal volume
- increase RR
- Shallow and quick breaths do not allow for good exhange in the respiratory zone which leads to a buildup of Pco2 and a decrease of Po2.
What diseases are casued by a defect in the intrapleural pressure?
- Restrictive diseases
- There is an inability to produce a negative pressure which does not allow for full chest exansion and therefore a decrease in the amount of ari that enters the alveoli.
Also pneumothorax- IP = 0
What diseases are caused by a defect in the lung recoil?
- Obstructive diseases
- Inability to produce a positive alveolar pressure which means air does not leave the alveolus.
- Hyper-resonant on percussion becasue the alveoli are filled with air.
How can you decrease Pao2?
By decreasing the PAo2 via decreasing Patm or decreasing Fio2.
CO has a higher solubility and higher affinity for Hb. So what would limit uptake of CO?
Structural features of the lung
What are the 3 components of O2 content?
If you decrease atmospheric pressure does this affect Oxygen content in the blood. How and why?
It decreases oxygen content.
Patm decrease -> PAo2 decreases -> Pao2 decreases -> which is a component of oxygen content in the body.
Hypoxia stimulate hyperventilation via which receptors?
How do you get Expiratory reserve volume?
Vital capacity - Inspiratory capacity
(IC = TV + IRV)
CO2 transport in venous blood
- CO2 + H2O -> H+ + HCO3
- Deoxygenated RBC bind H+
What is the reid index and when is it used?
Ratio of the gland depth to the total thickness of the bronchial wall.
Increased in Chronic bronchitis
Helium dilution technique is used to measure what?
RV and functional residual capacity.
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