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PAM Semester 3 > Clin Med Pulmonary exam 1 > Flashcards

Clin Med Pulmonary exam 1 Flashcards

1
Q

Where does the O2 ultimately go?

A

Mitochondria (ATP)

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2
Q

Where does gas exchange occur?

A

Alveolia and capillary

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3
Q

3 Factors that affect gas exchange

A

Surface area
respiratory membrane
blood supply (amount)

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4
Q

Trace the airway tree all the way to capillary

A 
Oral cavity 
Oropharnyx
larnyx
trachea
carina
primary
secondary
tertiary
smaller bronchioles
bronchioles
terminal bronchioles
respiratory bronchioles
Alveolar sacs
Alveoli
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5
Q

WHere do the respiratory bronchiles start?

A

when you start to see alveoli

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6
Q

What about alveoli make it goor for gas exchange

A

good blod supply

thin membrane

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7
Q

How do bronchioles shange their radius?

A

they use smooth muscle

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8
Q

At what size do the bronchioles start?

A

1mm

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9
Q

what are the 2 functional zones of ventilation?

A

respiratory

conducting

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10
Q

How many total generations of ther ventilatory functional zones are there?

A

23 brnaches
16 in the conducting
7 in the respiratory

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11
Q

Describe conducting zone

A

Anatomical dead space (150ml)
16 branches
upper zone
conducts air to the respiratory zone

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12
Q

Describe respiratory zone

A

Respiration through bronchioles and alveoli
350ml normal value of participating air space
7 branches
this is where gas exchange occurs

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13
Q

Describe dead space

A

where no respiration occurs

150ml normal value

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14
Q

normal tidal volume

A

500ml

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15
Q

What secretes mucous in lungs?

A

goblet cells

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16
Q

WHat are cilia extensions of?

A

plasma membrane

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17
Q

Describe mucous elevator

A

cilia brings mucous and particles up airway to oral cavity where they are swalloed
similar to mexican wave

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18
Q

Is there mucous and cilia in respiratory zone

A

no, only in the conducting zone

Macrophages are in respiratory zone

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19
Q

What is used to help keep respiratory zone clean

A

macrophages

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20
Q

Where is cartilage distribution in airway?

A

Cartilage gets less and less as you go down the conducting zone
none in respiratory zone
Cartilage is C shaped

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21
Q

Where is the smooth muscle distribution in the airway?

A

none at the top

lots in the bronchioles

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22
Q

What does smooth muscle do in the airway

A

Bronchoconstriction

bronchodilation

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23
Q

Where is there no goble cells, mucous, cilia, cartilage

A

Respiratory zone

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24
Q

What are muscles for inspiration

A

Diaphram
sternocleidomastoid
scalenes
external intercostal

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25
Q

Is inspiration active or passive?

A

active

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26
Q

Is expiration active or passive

A

passive (unless forced)

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27
Q

Describe expiration at rest

A

normal
passive
no energy expended
diaphragm relaxes recoil of lungs (which have elastic properties)

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28
Q

Describe forced expiration

A 
Cough, sneeze, balloon
Abdominal muscles
rectus abdominus
external obliques
internal intercostals
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29
Q

Describe the rib movement on respiration

A

Like a bucket handle
on inspiration they go up and out
on exhalation they go down and in

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30
Q

Describe pressure gradient fro inspiration vs expiration

A

Gas moves from high pressure to low pressure

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31
Q

How do we change pressure in the lungs

A

we change the volume which changes the pressure

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32
Q

how does pressure change on inspiration

A

the volume increases and the pressure drops which allows air to flow in

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33
Q

How does pressure change on expiration

A

teh volume decreases, the pressure then increases which expels air

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34
Q

What is the complete process for inspiration

A 
the inspiratory muscle contract
the diaphragm decends
the rib cage rises
THoracic cavity volume increases
the lungs are stretched
the intrapulmonary volume increases
the intrpulmonary  pressure decreases
Air then flows into the lungs down the pressure gradient
The air continnues until pressure equalizes at 0 atm
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35
Q

What is the complete process for expiration

A 
inspiratory muscles relax
diaphragm rises
rib cage descends
thoracic cavity volume decreases
intrpulmonary pressure increases
air flows out of lungs
down pressure gradient until 0 ATM
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36
Q

WHat shape is the diaphragm

A

concave when relaxed

flattens out when it contracts

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37
Q

What do muscles do on inspiration

A

diaphragm moves inferiorly and flattens out
intercostals increase latteraly
sternocleidomastoid and scalene help superiorly

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38
Q

what is the P in PO2and PCO2

A

partial pressure

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39
Q

What is the total pressure at sea level

A

760mmhg

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40
Q

what is percentage of oxygen on earth regardless of altitude

A

21% o2
79% nitrogen
1% everything else

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41
Q

What is PO2 when inhaled

A

160mmhg

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42
Q

What is PO2 in alveoli

A

104mmhg

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43
Q

what is PO2 in arterial blood?

A

95mmhg

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44
Q

What is the PO2 in the tissues/capillary

A

40mmhg

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45
Q

WHat happens when the arterial blood at 95mmhg reaches the capillaries at 40mmhg?

A

the O2 in the blood will go down the pressure gradient and into the tissue

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46
Q

What is the PO2 of the venous blood

A

40mmhg

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47
Q

Trace PO2 pressure through circulation

A 
inhaled 160mmhg
lungs 104
arterials 95
capillaries 40
venous 40
lungs 104
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48
Q

What happens to the deoxgenated blood when it gets back to the lungs in regards to pressure

A

the O2 inhaled at 160mmhg travels down the pressure gradient and oxygenates the blood returning to the lungs at 40mmg to restart the cycle.

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49
Q

What is the nitrogen air percentage inhaled and exhaled

A

79% for both, doesn’t change

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50
Q

What is O2 percentage in haled and exhaled

A

21% inhaled
15-18% back out
the more intense the exercise, the less the %

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51
Q

What is the CO2 percentage inhaled and exhaled

A

0.04% inhaled
3-5% back out
HIgher instenisty activity, higher percentage

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52
Q

What is H2O percentage in haled and exhaled

A

.46% in
.46% out
No change

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53
Q

WHat is co2 pressure in arterials

A

40%

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54
Q

What is CO2 pressure in capillaries

A

46%

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55
Q

Why don’t we need as much of a pressure gradient for CO2

A

it is more soluble

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56
Q

How does CO2 get back into blood i the tissue

A 
travels down pressure gradient
46% in tissue
40% in blood
travels through venous system
and exhaled
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57
Q

What prevents natrual airway collapse

A

the intrapleural sac
a negative pressure between the two pleurae
suction force
causes chest wall and lung to move together

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58
Q

with a pneumothroax, what does the loss of negative pressure allow?

A

it allows the recoil of the lungs to happen and the lungs collapse
lung pulls away from chest wall
lung becomes inefficeint due to loss of surface area

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59
Q

What does the alveolar cycle mimic?

A

the lung cycle

inhalation and exhalation

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60
Q

Trace alveolar cycle

A 
Inspiratory muscles contract
thoracic cavity expands
pleural pressure becomes more negative
transpulmonary pressure increases
lungs inflate
alveolar pressure becomes subatmospheric
air flows into the lungs until alveolar pressure equals atmospheric pressure
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61
Q

What does spirometry measure

A

lung volume

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62
Q

On a PFT report, what does a downward deflection represent?

A

expiration

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63
Q

On a PFT report, what does a upward deflection represent?

A

Inspiration

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64
Q

PFT Inspiration categories

A

IRV Inspiratory reserve volume 3.1 liters

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65
Q

PFT expiratory categories

A

ERV expiratory reserve volume 1.2 liters
RV Residual volume 1.2 liters
FRC functional residual capacity 2.4 liters

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66
Q

PFT Both inspiratory and expiratory categories

A

VT tidal volume (500ml)
IC inspiratory capacity 3.6 liters
VC Vital capacity 4.8 Liters
TLC total lung capacity 6 liters

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67
Q

What is FVC?

A

Forced vital capacity
maximum amount of air forcibly exhaled at a maximum inhalation
4.8L

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68
Q

What is FEV1/FVC

A

Forced expired volume / forced vital capacity ratio
Percentage of FVC exhaled in 1 sec
80% is normal

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69
Q

What is FEV1

A

forced expiratory volume
Maximum volume of air forcibly exhaled in 1 second
4.0L

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70
Q

What is TLC

A 
Total lung capacity
The volume of air in the lungs at the end of maximum inspiration
Everything on graph combined
IRV+VT+ERV+RV=TLC
6L
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71
Q

WHat is VC

A

Vital capacity
Maximum volume of air that can be exhaled
IRV+VT+ERV=VC
4.8L

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72
Q

WHat is IC

A

Inspiratory capacity
Maximum amount of air inhaled at end of normal inspiration
VT+IRV=IC
3.6L

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73
Q

What is VT

A

Tidal volume
Volume of air inhaled and exhaled with each normal breath
500ml

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74
Q

What is FRC

A 
Funtional residual capacity
Volume of air remaining in lungs at the end of normal tidal volume
ERV+RV=FRC
2.4L
(Expiration)
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75
Q

WHat is RV

A

Residual Volume
Volume of air remaining in lungs after maximum exhalation
1.2L
(Exhalation)

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76
Q

What is ERV

A

Expiratory reserve volume
Maximum volume of air exhaled at end of tidal volume
1.2L
(exhalation)

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77
Q

What is IRV

A

Inspiratory reserv volume
Maximum volume of air inhaled at the end of normal inspiration
1.2L
(Inspiration)

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78
Q

Wha tis normal percentage for FEV1/FVC ratio

A

80%

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79
Q

WHat is normal FEF

A

25-75

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80
Q

In obstructive disorder what does FEV1/FVC ratio do

A

decrease

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81
Q

In obstructive disorder what does FVC do

A

Decrease or could be normal

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82
Q

In obstructive disorder what does FEV1 do

A

Decrease

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83
Q

In restrictive disorder what does FEV1/FVC do

A

Normal or increases

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84
Q

In restrictive disorder what does FEV1 do

A

decrease

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85
Q

In restrictive disorder what does FVC do

A

decrease

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86
Q

Examples of obstructive disorders

A

Emphysema
Chronic bronchitis
bronchiectasis
asthma

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87
Q

Examples of restrictive disorders

A 
intersitual lung disease
idiopathic pulmonary fibrosis
pneumoconiosis
sarcoidosis
chestwall neurmuscular disease
88
Q

Why dont lung disease spread to the other lung typically

A

lungs are seperatate and comparmentalized

89
Q

Describe the restrictive disorder

A

Reduced expansion of lung parenchyma accompanied by decreased lung total capcacity

90
Q

Describe obstructive disorder

A

Limitation of airflow due to partial or compele obstruction

91
Q

WHat is minute ventilation

A 
tidal volume times respiration rate
ve=vt x f
example
500 x 12 = 6000
not really important compared to alveolar ventilation
92
Q

What is alveolar ventilation

A 
subtract the dead space from the tidal volume
then multiply times respiration rate
example
500-150 =350
350 x 12 = 4200
93
Q

How is alveolar vetilation calculated

A

by measuing a persons expired CO2

94
Q

What happens to CO2 in hypoventilation?

A

retain more CO2

more CO2 in blood

95
Q

What happens to CO2 in hyperventilation?

A

Blow off more CO2

Blood becomes more basic

96
Q

What is hypernea

A

INcreased breathing and metaboic rate due to exercise

97
Q

what is the relationship between PAco2 and alveolar ventilation

A

they are inversely related

98
Q

What does lung compliance measure

A

distensibilty

99
Q

Will it be harder or easier to breath if lung compliance is low

A

harder

it will be more difficult to inhale due to a stiffer lung

100
Q

Will it be harder or easier to breath if lung compliance is high

A

it will be easier

less work to inflate the lung

101
Q

how does gravity affect the alveoli in the lung

A

The weight of the lung compress the alveoli in the base of the lung

102
Q

contrast the alveoli in the base of the lung verse the apex

A

at the base, they are small alveolus that can expand greatly and have high comliance

at the apex, alveolus are larger, respiration is poorer, they change very little in size and the compliance is low

103
Q

WHat does surfactant do?

A

lowrs the surface tension and stabalizes alveoli at low lung volumes
it is like dish soap
reduces the tendency of alveoli to stick together
keeps alveoli from collapsing

104
Q

What cells secrete surfactant

A

Type 2 endothelial cells

105
Q

What kind of cells are type 1 endothelial cells

A

simple squamous

106
Q

How does alveolar surface tension affect lung compliance

A

Increased surfactant = increased compliance
less surfactant = less compliance
increased comliance = increased volume at a givn pressure

107
Q

Is ther more surfactnat in smaller or larger alveoli

A

Smaller alveoli have more surfactant
larger alveoli have less surfactant
this negates any pressure gradient and keeps the alveoli from collapsing

108
Q

What are the cells of the alveoli

A

simple squamous epithlial
1 layer
flat squashed cells

109
Q

Are the majority of the alveoulus type 1 or type 2 cells

A

type 1 cells make up majority

110
Q

Are alveoli seperate or connected

A

they are all connected via pores

111
Q

Why do alveoli have macrophages

A

they have no cilia or mucous

112
Q

Select the correct statement about the physical factors influencing pulmonary ventilation.
A. A decrease in compliance causes an increase in ventilation.
B. B. A lung that is less elastic will require less muscle action to perform adequate ventilation.
C. C. As alveolar surface tension increases, additional muscle action will be required.
D. D. Surfactant helps increase alveolar surface tension

A

C. C. As alveolar surface tension increases, additional muscle action will be required.

113
Q

Which of the following would best characterize pulmonary function in a patient with asthma?
A. Maximal expiratory airflow is increased from normal.
B. B. Residual volume is decreased from normal.
C. C. Forced vital capacity is increased from normal.
D. D. Resistance to airflow is increased from normal.
E. E. The FEV1/FVC ratio is increased.

A

D. D. Resistance to airflow is increased from normal.

114
Q 
An individual has an alveolar ventilation of 6,000 mL/minute, a tidal volume of 600 mL, and a breathing rate of 12 breaths/minute. What is this individual’s anatomic dead space? 
A.	100 mL 
B.	B. 120 mL 
C.	C.150 mL 
D.	D. 200 mL
A

A. 100 mL

6000 = (600 - X)12 solve for X
6000 /12 = 500
500 = 600 - X
500 – 600 = -100
-100 = -X
X= 100
115
Q

pressure at sea level vs alitutde

A

Sea level 760mmhg = PO2 = 160

Mt everest 253 mmhg = PO2 = 53

116
Q

FIO2

A

21% O2

117
Q

Whenis partial presure of O2 highest?

A

when it leaves the lungs

118
Q

When is Partial pressure of CO2 highest

A

when it enters the lungs

119
Q

How are distance and diffusion related

A

distance reduces efficiency of diffusion

120
Q

What is lung diffusion capacity

A

the ability of the lungs to transfer gases

121
Q

How does diffusion relate to hematocrit and blood volume

A

If you decrease hematocrit you will decrease diffusion capacity
if you decrease blood volume, you will decrease diffusion capacity
low cardiac output, anemia, blood loss

122
Q

How much O2 does arterial blood carry?

A

20ml of O2 per Deciliter

123
Q

What is O2 bound hemoglobin called

A

oxyhemoglobin

124
Q

What is no O2 bound to hemoglobin called

A

deoxyhemoglobin

125
Q

What is CO2 bound hemoglobin called

A

carboxyhemoglobin

126
Q

How is oxgen transported % wise

A
  1. 5 % is bound in hemoglobin

1. 5% dissolved in plasam

127
Q

WHere does the O2 bind to hemoglobin

A

it binds to the iron that is in the Heme

128
Q

Where does the CO2 bind in hemoglobin

A

it binds to the globin

129
Q

What happens as more and more O2 binds to Hemoglobin

A

it causes more and more CO2 unbinding

130
Q

What happens as more and more CO2 binds to hemoglobin

A

it causes more and more O2 to unbind

131
Q

What is the plateua phas ein the oxyhemoglobin dissociation curve

A 
Loading phase (lungs)
where there is a high affinity for hemoglobin in the lungs
132
Q

What is the steep phase of the hemoglobin dissociation curve

A 
unloading phase (tissues / capillaries)
Low affnity for hemoglobin in tissues
133
Q

What causes sigmoidal shape in hemoglobin dissociation curve graph

A

The cooperative binding

134
Q

What does a right shift on the graph represent

A

increases oxygen unloading

135
Q

What does a left shift on the graph represent

A

increased oxygen loading

136
Q

What is p50 for hemoglobin

A

the 50% saturation rate of hemoglobin

137
Q

What are factors that can cause right shift on the hemoglobin dissocation graph (increased unloading)

A 
INcreased Temperature
INcreased CO2
INcreased H+
INcreased BPG 
increased workload
138
Q

How is most of the CO2 in the blood transported

A

in the plasma as bicarbonate
60-70%
30% is bound to hemglobin as carbamino
10% is dissolved in the plasma

139
Q

What is carbonic anhydrase reaction

A 
CO2 + H2O ←CA→ H2CO3 ↔ H+ + HCO3-
CO2 combines with H2O
and using carbonic anhydrase
makes carbonic acid
Carbonic acid then dissociates into H+ and bicarbonate
Occurs in the Red blood cells
This equation occurs in the tissues/capillaries
the reverse occurs in thelungs
140
Q

What happens to the charge when HCO3- leaves the red blood cell

A

a Cl- ion enters to balance the charge

Known as chloride shift

141
Q

What is chloride shift

A

when a HCO3 leaves a red blood cell and a cl- enters in order to balance the charge

142
Q

where does this equation occur?

CO2 + H2O ←CA→ H2CO3 ↔ H+ + HCO3-

A

in the tissue/capillaries
Forward in lungs,
backwards in tissues
the reverse equation occurs in the lungs

143
Q

Where does this equation occur?

H+ + HCO3- ↔ H2CO3 ←CA→ H2O + CO2

A

In the lungs
Forward in lungs,
backwards in tissues
the reverse occurs in the tissus/capillaries

144
Q

What is reverse chloride shift

A

the HCO3 enters the red blood cell while a cl ion leaves

145
Q

Which of the following increases oxygen unloading from hemoglobin?
A. increased carbon dioxide in the tissue
B. increased oxygen levels in the tissue
C. increased blood pH
D. decreased metabolism
E. decreased temperature

A

A. increased carbon dioxide in the tissue

146
Q

Which of the following will most likely lead to decreased oxygen exchange at the respiratory membrane in a healthy individual?
A. Increased cardiac output, low atmospheric PO2
B. Increased pulmonary capillary recruitment, exercise
C. Decreased O2 diffusion distance in the alveolar–capillary membrane
D. Decreased alveolar PO2

A

D. Decreased alveolar PO2

147
Q 
If alveolar ventilation is held constant, which of the following predicted changes in alveolar oxygen and carbon dioxide tensions would occur when metabolic rate is increased? 
PACO2      PAO2 
A Increases Increases 
B Increases Decreases 
C Increases No change 
D Decreases Decreases
A

B Increases Decreases

148
Q

What is the differnec betweent he bronchiole circulation and the pulmonary circulation

A

they are seperate
Bronchial circulation is to nourish the conducting airways
Pulmonary circulation is gas exchange

149
Q

What is the primary function of bronchiole circulation

A

to nourish conducting zone

150
Q

What is the primary function of pulmonary circultion

A 
Primary is gas exchange
Secondary are
flitering (thrombi)
Metabolic organ (ACE)
Blood source (10% volume)
151
Q

What are secondary functions of pumonary circulation

A 
Primary is gas exchange
Secondary are
flitering (thrombi)
Metabolic organ (ACE)
Blood source (10% volume)
152
Q

as cardiac output decreases, what happens to resistance in the vascular system

A

it is inverse

it increases

153
Q

as cardiac output increases, what happens to resistance in the vascular system

A

it is inverse

it decreases

154
Q

is the pulomnary circuit high pressure or low pressure

A

unlike systemic circuit

the pulmonary ciruit is low pressure

155
Q

is pulmonary circuit normally dialated or constricted

A

Pulmonary circuit is normally dialated

systemic circuit is normally constricted

156
Q

which side has greater cardic output, the left or the right

A

Neither, they are equal
Pressures differ
volumes are the same

157
Q

What can increase capillary recruitment in the lungs

A

increased cardiac output

158
Q

How does pulmonary circulation help decrease resistance when arterial pressure rises

A 
Capillary recruitment
Capillary distention
Due to more capillaries
capillaries in parallel
more distented capillaries
159
Q

What does capillary recruitment do in the lungs

A 
when cardiac output increases, capillary recruitment can effect a marked decrease in pulmonary vascular resistance
Due to more capillaries
capillaries in parallel
more distented capillaries
helps decrease pulmonary edema
160
Q

What does capillary distetion do in lungs?

A

increases capillary surface area
increase gas exchange
helps decrease pulmonary edema

161
Q

When does pulmonary vascular resistance increase?

A 
At hig and low lung volumes
At low volumes
extra alveolar compress
at high lung volumes
alveolar vessles compress
162
Q

What are factors that can effect fluid exchange in the capillaries

A

alveolar surface tension which enhances filtration

Alveolar pressure which opposes filtration

163
Q

Which enhances filtration?
Alveolar surface tension
or
Alveolar pressure

A

Alveolar surface tension

164
Q

Which opposes filtration?
Alveolar surface tension
or
Alveolar pressure

A

Alveolar pressure

165
Q

WHat helps to keep the alveoli dry and avoid edema

A

a low pulmonary capillary hydrostatic pressure

166
Q

what is the most frequent cause of pulmonary edema

A

increased capillary hydrostatic pressure

this is due to abnormally high pulmonary venous pressure

167
Q

what is the second major cause of pulmonary edema

A

First is increased capillary hydorstatic pressure

second is noncardiogenic and is due to increasd alveolar tension

168
Q

How is blood flow distributed in the lungs

A

Blood flow is more copius at the base and dimishes towards the apex

169
Q

How many zones are there for blood flow in the lungs

A 
3 zones
zone 1 is at top (apex)
   no perfusion, no gas exchange
Zone 2 is in middle
   a little, but not a lot of gas exchange
Zone 3 is at base
   Largest rate of blood flow
   Best gas exchange occurs here
170
Q

How does gravity affect the the perfusion, and ventilation ratio in the lung

A

In the apex, there is hig ventilation but poor perfusion
this gives a high number for ratio
in the base there is low ventilation but good perfusion
gives a low number for ratio

171
Q

What does low oxygen tension in the lungs cause

A

pulmonary vasoconstriction

172
Q

what does regional hypoxia in the lungs cause

A

regional vasoconstriction which isolates poorly ventilated areas

173
Q

What dos general hypoxia cause in the lungs

A

General hypoxia causes vasoconstriction thoughout the lungs,

in other vessels outsod eof the lungs, hypoxia causes vasodialation

174
Q

WHen you have hypoxia why do the lungs vasoconstrict

A

This increases resistance and pilmonary artery pressure

175
Q

When do the lungs change ventilation to match changes in perfusion

A

decreased blood flow and less co2 in the Alveoli is the stimulus for the bronchioles to constrict.
this reduces the air flow so tht it matches the blood flow

176
Q

When do the lungs change perfusion to match changes in ventilation

A

decreased airflow which reduces PO2 in blood vessels which causes vasoconstriction
this results in decreased bloodflow to match the decreased air flow

177
Q

What happens to ventilation perfusion ratio if there is an airway Obstruction

A

In normal airway, airway is open, capillaries are open, there is good gas exchange, minimal shunting of air or blood (wasted air/blood)

In obstruction
this causes low ventilation / perfusoin ratio
we are underventilated compared to ou blood flow
increases wasted blood (shunting)
increases venous admixture

178
Q

What happens to ventilation perfusion ratio if there is an capillary obstruction

A

In normal airway, airway is open, capillaries are open, there is good gas exchange, minimal shunting of air or blood (wasted air/blood)

This will cause a high ventilation / perfusion ratio
over ventilated compared to blood flow
this will increase wasted air (psyiological dead space)

179
Q

Which of the following would be predicted to occur in a healthy individual, who has a 50% increase in his cardiac output?

 Pulm Blood Flow       Cap Recruitt        PulmVasc Resist
A Increases			 Increases 		Decreases 
B Increases			 Increases		 Increases 
C Increases 			No Change 		Decreases 
D No change 			Increases 		No change
A

A Increases Increases Decreases

180
Q

Which of the following best characterizes alveoli that are well ventilated but are poorly perfused?
A. They are most likely to occur with a partially plugged airway.
B. They are most likely to occur at the base of the lung.
C. PO2 is high in these alveoli, while PCO2 is low.
D. PO2 is low in these alveoli, while PCO2 is high.
E. Both PO2 and PCO2 are normal.

A

C. PO2 is high in these alveoli, while PCO2 is low.

181
Q

Most of the oxygen in the pulmonary capillaries is delivered to the heart from the base rather than from the apex of the lungs. This is primarily due to the fact that
A. the high V/Q ratio occurs at the base of the lungs.
B. the base of the lungs receives more ventilation than the apex.
C. the base of the lungs has a higher blood flow than the apex.
D. more shunted blood occurs at the lung apex.
E. the PO2 is lower in capillary blood leaving the lung apex than at the base.

A

C. the base of the lungs has a higher blood flow than the apex.

182
Q

WHere are the respiratory centers?

A

The medulla and the Pons

183
Q

What are the two respiratory cneters in the medulla

A

DRG and VRG
DRG or dorsal respiratory group
is in nucleus of the tractus solitirus
primarily for inspiration

VRG or ventilatory respiratory group
is in the nucleus ambiguos and nucleus retroambiguos
it has both inspiratory and expiraotry neurons
VRG expiration is active, unlike normal expiration which is passive

VRG is larger

184
Q

WHat is the DRG

A

DRG or dorsal respiratory group
is in nucleus of the tractus solitirus
primarily for inspiration

185
Q

What is VRG

A

VRG or ventilatory respiratory group
is in the nucleus ambiguos and nucleus retroambiguos
it has both inspiratory and expiraotry neurons
VRG expiration is active, unlike normal expiration which is passive

VRG is larger

186
Q

Describe role of phrenic nerve

A

Somatic nerve in charge of respiration
Controls diaphragm
c3,4,5, keep the diaphragm alive

187
Q

WHat are the two types of chemo receptors

A

central and peripheral
THese are not sensitive to changes in O2
dont detect O2 changes until around 40mmhg
Very sensitive to CO2

188
Q

Describe peripheral chemoreceptors

A

Carotid sinus
aortic arch
Receptors for CO2, H+ and O2

189
Q

Describe Central chemoreceptors

A

IN lungs
Receptors for CO2 mainly
but also H+

190
Q

What are the three types of receptors in the lungs

A

Chemoreceptors
mechanoreceptors
muscle propioceptors

191
Q

What do muscle proprioceptors do in the lung

A

They are used for the feed forward mechanism

192
Q

Describe the mechanoreceptors in the lung

A

Stretch receptors
J receptors (juxtaposed)
activated by engourgment of pulmonary capillaries
Irritant receptors
Typically stimulate respiratory cneter but can
depress it

193
Q

Where does voluntary control of respiration come from

A

cerebrum
hold breath
breath faster or slower

194
Q

How is everything relayed to the respiratory centers in pons and medulla

A 
signals are relayed to spinal motor nerves
ie the phrenic nerve
then they are relayed to
diaphragm
intercostals
acessory muscles
muscles of respiration
195
Q

describe neural reflexes in the control of breathing

A

as CO2 goes up, minute vetilation goes up
(linear relationship, straight line)
CO2 is powerful stimulus for ventilation

O2 is not the same, it needs to drop a really long ways to have any changes in ventilation
(to around 40mmhg)

Central and peripheral chemoreceptors detect the changes
they respond to changes in arterial blood gases
and
H+ ion concentrations

196
Q

Talk about the blood brain barriers role in ventilation

A

The BBB is impermeable to H+ and HCO3
It is permeable to CO2
this can cause rapid changes in acid base status
The more CO2, the more ventilation

197
Q

CO2 in relation to ventilation

A

the more CO2 the more ventilation

198
Q

The increase in ventilation from moderate exercise in a healthy individual is caused by:

A. an increase in lactic acid production.
B. an increase in arterial PCO2.
C. a decrease in arterial PO2.
D. a decrease in the pH of brain extracellular fluid.
E. an increase in limb joint and muscle receptor excitation.

A

E. an increase in limb joint and muscle receptor excitation.

199
Q

A patient suddenly has a decrease in her arteriolar PO2. Which of the following statements best describe the ventilatory response to the decreased arteriolar PO2?

A. The response is mediated by both peripheral and central O2 chemoreceptors.
B. The response is mediated by peripheral O2 chemoreceptors.
C. The response is mediated by O2-sensitive chemoreceptors in skeletal muscle.
D. The response is mediated by O2-sensitive chemoreceptors in the alveolar capillary membrane.

A

B. The response is mediated by peripheral O2 chemoreceptors.

200
Q

A newborn inhales and stimulates the stretch receptors in the airway smooth muscle.
This will:
A. inhibit inspiration and stimulate expiration.
B. stimulate depth of breathing and oxygen uptake in the lung. C. inhibit depth of breathing and stimulate shallow breathing.
D. stimulate depth and rate of breathing.

A

A. inhibit inspiration and stimulate expiration.

201
Q

A 50-year-old man with a persistent cough and difficulty breathing is referred
by his family physician for pulmonary function tests. The test results show
that the forced vital capacity (FVC), forced expired volume in 1 s (FEV1), and
functional residual capacity (PRC) are all significantly below normal. Which
of the following diagnosis is consistent with these pulmonary function test
results?

A. Asthma
B. Chronic bronchitis
C. Emphysema
D. Pulmonary fibrosis

A

D. Pulmonary fibrosis

202
Q
  1. A 19-year-old man is taken to the emergency department after being stabbed
    in the right side of the chest. ‘Ihe entry of air through the wound resulted in a
    pneumothorax on the right side of his chest What difference between the right
    and left sides of the chest would be apparent on a plain chest x-ray?

A. ‘Ihe lung volume on the right would be larger
B. The position of the diaphragm on the right would be higher
C. The thoracic volume on the right would be larger
D. There would be no dllferences in thoracic geometry

A

C. The thoracic volume on the right would be larger

203
Q

A 28-year-old man is involved in a high-speed motor vehicle accident in which
he suifers multiple rib fractures. On arrival at the emergency department. he
is conscious but in severe pain. His respiratory rate is 34 breaths/min, and his
breathing is labored. His blood pressure is 110/95 mm Hg, and his pulse is 140
beats/min. His arterial Po2 is 50 mm Hg, and he is unresponsive to supplemental 0 1
• His arterial Pco2 is 28 mm Hg. What is the most likely cause of this
patient’s hypoxemia?

A. Alveolar hypoventilation
B. High ventilation/perfusion (V / Q) ratio
C. Increased dead space ventilation
D. Intrapulmonary shunt
E. Low V/Q ratio
A

D. Intrapulmonary shunt

204
Q

A 16-year-old girl is found unconscious in the street. She has no visible injuries
but is cold and is taking shallow breaths at a rate of 6-8 per minute. An arterial blood gas analysis recorded in the emergency department shows that her
Po2 is 55 mm Hg and her Pco2 is 75 mm Hg. What is the most likely cause of
hypoxemia in this patient?

A. Alveolar hypoventilation
B. High ventilation/perfusion (V / Q ) ratio
C. Increased dead space ventilation
D. Intrapulmonary shunt
E. Low V/ Q ratio
A

A. Alveolar hypoventilation

205
Q

A 62-year-old man with a history of COPD is admitted to the hospital due to
acute deterioration in lung function as a result of a viral chest infection. An
anal}’5is of arterial blood gases shows that his Po2 is 60 mm Hg and his Pco1 is
70 mm Hg. His exhaled minute ventilation rate is two times higher than that of
a normal individual of the same age and body size. He has hypercapnea. despite
having an increased exhaled minute ventilation rate because his

A. alveolar ventilation is increased
B. dead space ventilation is increased
C. VT is increased
D. ventilation/perfusion (V / Q) ratio is decreased
E. intrapulmonary shunt is increased
A

B. dead space ventilation is increased

206
Q

A 40-year-old woman presented with dyspnea, hematuria, and right flank pain.
CT scans revealed a renal tumor, with an extensive venous thrombus that hadnvaded the inferior vena cava. Fragments of the thrombus had entered the
lungs and were blocking several major branches of the pulmonary arteries.
Aasuming that there was no change in VT or respiratory rate, what effect would
these pulmonary emboli have on arterial blood gases within the first few minutes of their occurrence?

A. Decreased Pco2 and decreased Po2
B. Decreased Pco2 and increased Po2
C. Increased Pco2 and decreased Po2
D. Increased Pco2 and increased Po2
E. No change in Pco2 or Po2
A

C. Increased Pco2 and decreased Po2

207
Q

A 9-ycar-old boy decided to find out for how long he could continue to breathe
into and out of a paper bag. After approximately 2 minutes, his friends noticed
that he was breathing very rapidly so they forced him to stop the experbnent.
What change in arterial blood gas composition was the most potent stimulus
for this boy’s hyperventilation?

A. Dcacased Pco2
B. Decreased Po2
C. Decreased pH
D. Increased Pco2
E. Increased Po2
F. lncrcaacd pH
A

D. Increased Pco2

208
Q

A 54-ycar-old woman with advanced emphysema due to many years of cigarette smoking is admitted to the hospital because of severe peripheral edema
and shortness of breath. On physical examination, there is jugular venous distension and a widely split second heart sound with a loud pulmonic sound. A
differential diagnosis of right heart failure and pulmonary hyperte1U1ion is confirmed by cardiac cathetmzation. The results of her arterial blood gas analpiis
show Po2 = 55 mm Hg, Pco2 = 75 mm Hg, and pH = 7.30. What is the most
lilccly cause of pulmonary hypertension in this patient?

A. Decreased alveolar Po2
B. Decreased lung compliance
C. Decreased parasympathetic neural tone
D. Increased alveolar Pco2
E. Increased thoracic volume
F. Increased sympathetic neural tone
A

A. Decreased alveolar Po2

209
Q

A group of medical students is experimenting with a peak flow meter in the
respiratory phy&iology laboratory. Two students decide to compete to see which
of them can blow the hardest into the device. Which of the following mwcles is
most effective at producing a maximal expiratory effort such as this?

A. Diaphragm
B. External intercostal muscles
C. Internal intercostal muscles
D. Rectus abdominus
E. Sternocleidomastoid
A

D. Rectus abdominus

210
Q

A 22-year-old man was involved in a :6.ght in which he received a severe blow
to the head. On arrival at the emergency department. he was unconscious and
initially received assisted ventilation via a manual bag-valve device. An analysis
of his arterial blood gases shows:
Po2 =45mmHg
Pco2 = 80 mm Hg
pH=7.05
HC0,-=27 mM
In what form was most col being transported in his arterial blood?

A. Bicarbonate ions
B. Carbaminohemoglobin comp

A

A. Bicarbonate ions

211
Q

A 67-year-old woman involved in a motor vehicle accident lost 1 L of blood
became of an open fracture of her left femur. Paramedics were able to prevent
further bleeding. What changes to her intracellular fluid (ICF) and extracellular
fluid (ECF) volumes would be observed 15 minutes after this blood loss?

A. ECF volume smaller; ICP volume unchanged
B. ECF volume smaller; ICF volume smaller
C. ECF volume unchanged; ICF volume unchanged
D. ECF volume unchanged; ICF volume smaller

A

A. ECF volume smaller; ICP volume unchanged

212
Q

1he following pressure measurements were obtained from within the glomerulus of an experimental animal:
Glomerular capillary hydrostatic pressure = 50 mm Hg
Glomerular capillary oncotic pressure = 26 mm Hg
Bowman’s space hydrostatic pressure = 8 mm Hg
Bowman’s space oncotic pressure = 0 mm Hg
Calculate the glomerular net ultrafiltration pressure (positive pressure favors
filtration; negative pressure opposes filtration).

A. +16mmHg
B. +68mmHg
C. + 84mmHg
D. Omm.Hg
E. -16mmHg
F. -68mmHg
G. -84mmHg
A

A. +16mmHg

213
Q

A novel drug aimed at treating heart failure was tested in experimental animals.
The drug was rejected for testing in humans because it caused an unacceptable
decrease in the glome.rular filtration rate (GFR). Further analysis showed that
the drug caused no change in mean arterial blood pressure but renal blood 1low
(RBF) wu increased. The filtration fraction wu decreased. What mechanism is
most likely to explain the observed decrease in GFR?

A. Afferent arteriole constriction
B. Afferent arteriole dilation
C. Efferent arteriole constriction
D. Efferent arteriole dilation

A

D. Efferent arteriole dilation

214
Q

A healthy 25-year-old woman was a subject in an approved research study. Her
average urinary urea excretion rate was 12 mglmin, measured over a 24-hour
period. Her average plasma urea concentration during the same period was
0.25 mg/mL. What is her calculated urea clearance?

A. 0.25 mL/min
B. 3mUmin
C. 48mUmin
D. 288 mLlmin

A

C. 48mUmin

215
Q

A 54-year-old woman received. a life-saving kidney transplant 6 months ago
and had been well until the p8$1 few days. She now reports severe fatigue and
dizziness upon standing. Urinalysis is positive for glucose, and there is excessive excretion of HC03 - and phosphate. In which segment of the nephron is
function most likely to be abnormal?

A. Proximal tubule
B. Loop of Henle
C. Distal tubule
D. Collecting duct

A

A. Proximal tubule

216
Q

A resident in internal medicine was called to the hospital room of an 85-yearold patient in the middle of night. The man was sitting up in bed coughing. and
was severely short of breath. Crackles heard in both lungs suggested pulmonary
ed.ema. Which diuretic is most appropriate for this patient?

A. Carbonic anhydrase inhibitor
B. Loop diuretic
C. Thiazide diuretic
D. Potassium-sparing diuretic

A

B. Loop diuretic

PAM Semester 3 (8 decks)

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