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Respiratory > EXAM #1: RESPIRATORY PATHOPHYSIOLOGY > Flashcards

EXAM #1: RESPIRATORY PATHOPHYSIOLOGY Flashcards

1
Q

What is the major factor that controls breathing?

A

1) PCO2

+

2) PO2
3) pH

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2
Q

Outline the neuro-anatomic pathway that controls breathing.

A

1) Increased PCo2
2) Central chemoreceptors
3) Central Pattern Generator
4) Spinal cord or cranial nerves
5) Respiratory muscles, chest wall/ diaphragm
6) Increased ventilation

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3
Q

At what generation does cartilage stop?

A

11

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4
Q

What generation marks the conducting airway/ anatomic dead space?

A

16

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5
Q

Where is smooth muscle most abundant in the airway?

A

Bronchioles

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6
Q

What two regions of the airway confer the greatest resistance to air flow?

A

Bronchus and bronchioles

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7
Q

List four factors that will increase airflow resistance.

A

1) Inflammation of bronchial epithelium
2) Secretions
3) Constriction
4) Physical blockade

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8
Q

Write the equation for resistance.

A

N/A

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9
Q

What is the resistance of airflow inversely proportional to?

A

r^4

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10
Q

What type of ANS receptors will increase airway resistance?

A

M3

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11
Q

What type of ANS receptors will decrease airway resistance?

A

B2

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12
Q

What are the obstructive pulmonary disorders?

A

1) Asthma
2) Bronchitis
3) Emphysema
4) Obstruction of the airway lumen (physical)

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13
Q

List some of the disorders that will obstruct the airway.

A 
Asthma 
Bronchitis 
Bronchiectasis 
Bronchiolitis 
CF 
Acute FB obstruction 
Epiglottitis 
Croup
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14
Q

Describe the blood flow around an alveoli.

A

Capillaries form a SHEET of flow around the alveoli

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15
Q

Describe the composition of the respiratory membrane from the alveolar side to the capillary side.

A

1) Surfactant
2) Alveolar epithelium
3) Epithelial basement membrane
4) Interstitial space*
5) Capillary basement membrane
6) Capillary endothelial cell membrane

This space is INCREASED in CHF

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16
Q

What are the major components of the lung interstitial space?

A

1) Connective tissue–elastin (like a balloon)
2) Smooth muscle
3) Lymphatics
4) Capillaries
5) Cells

*Under normal conditions this space needs to be v. small

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17
Q

Write the equation for the diffusion of a gas across a membrane.

A 
D= Diffusion of gas 
dP= difference in partial pressure 
A= surface area 
d= distance 
S= solubility
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18
Q

Which is more soluble, oxygen or carbon dioxide?

A

Co2

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19
Q

What factors will alter dP?

A

1) High altitude
2) Restrictive lung disease

*Note that you can control this will an oxygen mask

20
Q

What factors will alter d?

A

1) Pulmonary edema

2) Pneumonia

21
Q

What are the major components of the parietal pleura?

A

1) Parietal lymphatics
2) Stoma opening into the pleura space
3) Systemic capillaries

22
Q

What are the components of the visceral pleura?

A

Pulmonary capillaries

23
Q

What causes pleural effusion?

A

1) CHF i.e. increased pulmonary venous hydrostatic pressure
2) Decreased oncotic pressure
- Liver disease
- Nephrotic syndrome
3) Decreased pleural pressure from atelectasis
4) Blockade of lymphatic drainage (e.g. tumor at the stoma)

24
Q

What is the definition of a restrictive lung disorder?

A

Disorders that cause decreased expansion of the lungs

25
Q

What is lung compliance?

A

Extent to which the lungs will expand with an increase in transpulmonary pressure

*Note that this is the inverse of elasticity

26
Q

What are the primary intrinsic determinants of lung compliance?

A

Elastin and collagen

  • Increased elastin/collagen= decreased compliance
  • Decreased= increased compliance

*Note that things like CHF and pneumonia will also decreased lung compliance

27
Q

What are the types of restrictive lung disorders?

A

1) Fibrotic interstitial lung diseases
2) Atelectatic disorders (ARDS)
3) Pleural space disorders
4) NM disorders
5) Chest wall deformities
6) Infection/inflammation

28
Q

How does the pulmonary circulation differ from the systemic circulation?

A

1) Shorter
2) Thinner/more COMPLIANT
- Accommodate more volume in a shorter amount of space

29
Q

What artery is responsible for bronchial circulation? Where does the blood go after the bronchial capillaries?

A

Bronchial a. - broncial capillaries - pulmonary vein

*Note that this is deoxygenated blood going to the left heart and accounts for a lower oxygen saturation of arterial blood–this is “physiological shunting”

30
Q

What is hypoxic pulmonary vasoconstriction (HPV)?

A
  • Low oxygen content to alveoli
  • Surrounding vessels VASOCONSTRICT

*Avoids perfusing hypoxic areas

31
Q

What is the normal V/Q ratio? What is the normal V/Q ratio at the apex? Base? Why?

A

Normal= 0.8

Apex= 3, b/c there is wasted oxygen with less perfusion
Base= 0.6 b/c there is wasted perfusion
32
Q

What is a V/Q of infinity? What causes it?

A

Blood flow obstruction

  • Think PE
  • OR, physiologic dead space where there is normally no gas exchange
33
Q

What is a V/Q of 0?

A

Airway obstruction, also called “shunt”

*Bronchial circulation is a physiologic shunt

34
Q

What volume cannot be measured by spirometry?

A

Residual volume

35
Q

What is the normal tidal volume?

A

500 mL

36
Q

What is the total amount of air that can go in and out in a single breath?

A

Vital capacity

37
Q

What is FVC?

A

Forced Vital Capacity

38
Q

Draw the Flow-Volume curve.

A

N/A

39
Q

After one second of expiration, where are you on you the flow-volume curve?

A

FEF75

*75% of the Forced Expiratory Flow

40
Q

How will the Flow-Volume curve change in obstructive lung disease?

A

See ppt.

41
Q

How will the Flow-Volume curve change in upper airway obstuction?

A

See ppt.

42
Q

How will the Flow-Volume curve change in restrictive lung disease?

A

See ppt.

43
Q

What is a normal FEV1/FVC?

A

0.8

44
Q

What is the FEV1/FVC in obstructive lung disease?

A

Decreased i.e. less than 0.7

*Both decreased, but FEV1 more so

45
Q

What is the FEV1/FVC in restrictive lung disease?

A

Increased i.e. greater than 0.8

*Decreased FVC

Respiratory (35 decks)

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