Erin's Anatomy Exam 2 Flashcards
1
Q
How many scalene muscles do we have?
A
6
2
Q
We only need ___ phrenic nerve to survive if we are completely healthy
A
1
3
Q
What generation is the trachea?
A
0
4
Q
What generations are the bronchi?
A
1-3
5
Q
What generations are the bronchioles?
A
4
6
Q
What generations are the terminal bronchioles?
A
5-16
7
Q
What generations are the respiratory bronchioles?
A
17-19
8
Q
What generations are the alveolar ducts?
Alveolar sacs?
A
-Ducts: 20-22
-Sacs 23
9
Q
What 4 things are in the conducting zones?
A
- Trachea
- Bronchi
- Bronchioles
- Terminal bronchioles
10
Q
Diameter of the trachea
A
2 cm
11
Q
Cyanosis is classified as a deoxyHB of…
A
> 5 gm/dL
12
Q
1 mmHg = ? CmH2O
A
1.36 cmH2O
13
Q
O2 consumption is _____ mL/min
A
250 mL/min
14
Q
In between breaths, our pleural pressure should be ____ cmH2O
A
-5 cmH2O
15
Q
At the end of inspiration, our intrapleural pressure is ____ cmH2O
A
-7.5 cmH2O
16
Q
Peak inspiration occurs when alveolar pressure is at _____ cmH2O and airflow is at ____ L/s
A
-1 cmH2O
-0.5 L/s
17
Q
Zone 1 equation
A
PA > Pa > Pv
18
Q
Zone 2 equation
A
Pa > PA > Pv
19
Q
Zone 3 equation
A
Pa > Pv > PA
20
Q
Average blood flow through the lungs is
A
5L / min
21
Q
Explain inspiration and expiration with pressure and what the diaphragm is doing… image from class
A
22
Q
Alveolar pressure equation
A
PA = PIP + PER
23
Q
ER pressure equation
aka
Transpulmonary pressure equation
A
PER=PA-PIP
or
PTP=PA-PIP
24
Q
Active influences that increase pulmonary vascular resistance
A
PEA HATS Δ
-PGF2 alpha, PGE2
-Endothelin
-Angiotensin
-Histamine (pulmonary venoconstrictor)
-Acidosis (mixed venous)
-Thromboxane
-SNS / Epi / Norepi
- Change… Alveolar hypoxia / hypercapnia
25
Active influences that decrease pulmonary vascular resistance
-PGE`1`
-Beta-adrenergic agonists
-Stimulation of PSNS
-Nitric oxide
-Acetylcholine
-Prostacyclin (PGI`2`
-Bradykinin
(PB SNAP B)
26
Two most important passive forces that impact pulmonary vascular resistance
1. Gravity!!!!
2. Lung volumes
27
Passive things that impact pulmonary vascular resistance (9)
-Increased lung volume (above FRC)
-Decreased lung volume (below FRC)
-Increased CO
-Gravity / body position
-Increased (more +) interstitial pressure
-Increased blood viscosity
-Positive pressure ventilation
-Increased alveolar pressure
-Positive intrapleural pressure
(I dont care about very itchy ivy green plants)
28
Nitrogen DRY ATMOSPHERIC partial pressure? concentration?
Partial pressure: 600.3 mmHg
Concentration 79%
29
Oxygen DRY ATMOSPHERIC partial pressure? concentration?
Partial pressure: 159 mmHg
Concentration 21%
30
Partial pressure equation
Partial pressure = total pressure x [gas]
Example:
Partial pressure of oxygen:
760 x .21 = 159 mmHg
31
PI`O2` in humidified gas
149 mmHg
32
PI`N2 `in humidified gas
564 mmHg
33
PI`H2O`
47 mmHg
34
How to find the P`IO2`?
PIO2 = F`IO2` (P`B` - P`H2O`)
Example:
0.21 ( 760 - 47 ) = 149
35
Fresh air we breathe in has a P`O2` of....
A P`CO2` of...
P`O2` of 150 (149 to be exact)
A P`CO2` of 0
36
Alveolar PO2 and PCO2
P`O2` of 100 (or 104 for *most *accurate)
A P`CO2` of 40
37
How many mL of our tidal volume actually makes it all the way into the lungs for gas exchange?
350 mL
38
How many mL of our tidal volume is anatomical dead space?
150 cc
39
How to calculate anatomical dead space based on body weight
1 cc / lb of IBW
40
P`O2` and P`CO2` of the pulmonary artery / systemic venous blood
P`O2` of 40
A P`CO2` of 45
41
P`O2` and P`CO2` of the pulmonary vein / systemic arterial
P`O2` of 100
A P`CO2` of 40
Technically the pulmonary vein has a P`O2` of 104 mmHg! Systemic arterial is diluted out with deoxygenated blood from pulmonary tissue circulatory system.
42
The tissues of the lung have their own small circulatory system makes up about ___% of our cardiac output
1%
43
Alveolar gas at standard barometric pressure:
-PA`O2`
-PA`CO2`
-PA`N2`
-PA`H2O`
-PA`O2`: 100 or 104 (most accurate)
-PA`CO2`: 40
-PA`N2`: 569
-PA`H2O`: 47
all in mmHg!
44
If I increase my ventilation, but leave pulmonary blood flow unchanged, how does this impact my alveolar O2 and CO2?
-Alveolar O2 would be higher
-Alveolar CO2 lower
45
Typically, if I take in a 500 cc breath, the first ____cc will make it all the way into the lungs for gas exchange
350 cc
46
Typically, if I take in a 500 cc breath, the last ____cc will **not** make it deep enough into the lungs for gas exchange
150 cc
47
What makes up physiological dead space?
Alveolar dead space (bad) + anatomical dead space (normal)
48
True or false: a 100 year old man in picture perfect health will have a significant amount of alveolar dead space in comparison to a 20 year old healthy adult
True! This is inescapable
49
Minute ventilation equation
V`T` = V`E` = V`T` x BPM (n)
(First VT and VE would have dots over V! just can not do it in brainscapes!)
50
V`T` equation
V`T` = V`D` + V`A`
51
Alveolar ventilation equation using V`T`
(n)V`A` = (n)V`T`-(n)V`D`
52
Alveolar ventilation equation using minute ventilation
V`A` = V`E` - V`D`
(all would have dots over V! just can not do it in brainscapes!)
53
Normal minute ventilation and how you got it
6 L /min
V`T`x BPM
500 x 12 =6,000 mL
54
Normal alveolar minute ventilation and how you got it
4.2 L/min
(12 x 500) - (12 x 150) = 4,200 mL
(n) V`T` - (n) V`D`
55
Normal minute dead space ventilation and how you got it
1.8 L / min
VD(n)
150 x 12 = 1,800 mL
56
Could I find total minute ventilation if I had minute dead space ventilation and minute alevolar ventilation? If so, how?
Yes!
Minute dead space ventilation + min alveolar ventilation = total minute ventilation
so...
1.8 L (dead space) + 4.2 L (alveolar ventilation) = 6L = total minute ventilation
57
Pulmonary capillary starling forces:
P`C`
π`pl`
P`C`: 7 mmHg
π`pl`: 28 mmHg
58
Pulmonary interstitium Starling forces:
P`is`
π`is`
P`is`: -8 mmHg
π`is`: 14 mmHg
59
NFP of pulmonary capillary
How did you get it?
+1
7 + 14 + 8= 29
^ These favor filtration
29 - 28 (π`cap`; opposes filtration) = 1
| **This is 3x the systemic NFP! (0.3 mmHg)
60
In the graph, it shows that LAP can go all the way up to ___mmHg before it becomes a problem for pulmonary edema
23 mmHg
61
Two biggest risk factors for pulmonary edema formation
-Someone who has lost a lot of blood (and therefore proteins)
-Left heart failure
62
Q`f` equation
63
5 factors predisposing to pulmonary edema
| General factors, not specific
* Increased capillary permeability
* Increased capillary hydrostatic pressure
* Decreased interstitial hydrostatic pressure
* Decreased colloid osmotic pressure
* Insufficent pulmonary lymphatic drainage
* Also unknown etiology... see image
64
At FRC, the pleural pressures are:
Top of the lung:
Bottom of the lung:
Average:
Top of the lung: -8.5 cmH`2`O
Bottom of the lung: -1.5 cmH`2`O
Average: -5 cmH`2`O
65
At RV, the pleural pressures are:
Top of the lung:
Bottom of the lung:
Average:
Top of the lung: -2.2 cmH`2`O
Bottom of the lung: +4.8 cmH`2`O
Average: +1.3 cmH`2`O
66
At FRC, alveoli at the top of the lung are ___% full
60%
| Note the slope is less steep, these alveoli are less compliant!
67
At FRC, alveoli at the bottom of the lung are ___% full
25%
| This is why they accept air easier! They are more compliant.
68
Alveoli really can not be emptied more than to ____% of their capacity. Why?
20%
You push on the small airway and collapse it!
69
At RV, alveoli at the bottom of the lung are ___% full
20%
as empty as they can be!
70
At RV, alveoli at the apex of the lung are ___% full
30%
71
At RV, air prefers to go to the __ of the lung
At FRC, air prefers to go to the ___ of the lung
RV : top
FRC: base
72
Why is the base of our lung noncompliant at RV?
We had to generate a really positive pleural pressure to breathe that air out! This collapsed the small airways. Slope of line is zero at a transpulmonary pressure of -4.8!
73
At FRC the transpulmonary pressure is higher at the ___ of the lung. What does this mean?
Top of the lung!
The higher P`TP` keeps the alveolli more distended!
74
All vascular smooth muscle constriction is mediated by _____
General anesthetics open ____ channels
Membrane potentials!
Potassium channels
75
In a normal healthy adult, FRC goes down to ___ L in the supine position.
2L
We lose ERV due to the abdominal stuff pushing on diaphragm
| ERV shrinks; IRV expands
76
Possible indicator gases
-Helium
-Neon
-Argon
-Xenon
| Maybe Radon...?
77
This is the second leading cause of lung cancer, behind smoking
Radon gas!
78
6 things that make up surfactant
1. Surfactant protein A (hydrophilic)
2. Surfactant protein D (hydrophilic)
3. Surfactant protein B (hydrophobic)
4. Surfactant protein C (hydrophobic)
5. Dipalmitoylphosphatidylcholine
6. Phosphatidylcholine
79
Which surfactant proteins are water loving?
SP-A and SP-D
80
Surfactant is: __% lipids and ___% proteins
90% lipids
10% proteins
81
Dipalmitoylphosphatidylcholine makes up ___% of the surfactant
30%
82
Name the three cells that secrete surfactant
1. Goblet cells (a little bit)
2. Clara/club cells
3. Type II alveolar cells
83
Type I alveolar cells make up ___-___% of the gas exchange surface area
90-95%
84
Type II alveolar cells make up ___-___% of the gas exchange surface area
5-10%
85
Do we have more type I or type II alveolar cells?
How many more?
2x more type II alveolar cells
| However, they do not take up as much real estatr as the type I
86
How many alveoli do we have as young adults?
500 million
87
Each of the alveoli could have as many as ____ capillaries attached to it
1000
88
A 20 year old healthy adult should have _____ m^2 of surface area for gas exchange
70 m^2
This is the size of a tennis court
89
2/3 of our elastic recoil pressure is made up of....
1/3 is from.....
2/3: surface tension (of water)
1/3: tissue
90
Small airway resistance is generally a ___ dependent thing.
Large airway resistance is a ___ dependent thing
Small: volume dependent!
Large: Traction / intrapleural pressure
**We need a really low pleural pressure if we want a really high volume of air in our alveoli!**
91
The V/Q ratio is higher at the apex.
How does this impact PACO2 and PAO2?
PACO2 is lower at the apex, and PAO2 is higher at the apex.
This is in comparison to the base
92
If I have a blood clot blocking blood flow to small group of alveoli. What will their PAO2 and PACO2 be?
PAO2: 149
PACO2: 0
| They equilibrate with inspired air
