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22 spring: Physiology > exam 2 lecture 15 and 16 > Flashcards

exam 2 lecture 15 and 16 Flashcards

1
Q
A

gas flow or ventilation (L/min)

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2
Q
A

blood flow (ml/min) usually cardiac output

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3
Q

PIO

A

partial pressure of oxygen in inspired gas

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4
Q
A

alveolar gas flow/unit time or alveolar ventilation

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5
Q

PAO2

A

partial pressure of oxygen in alveolar gas

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6
Q

PaO2

A

partial pressure of oxygen in arterial gas

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7
Q

PaCO2

A

partial pressure of CO2 in arterial blood

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8
Q

a ventilator does what?

A

Create a positive pressure at the airway opening to push air into the lung

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9
Q

normal breathing is caused by ___ pressure

A

negative pressure within the lung to suck air in

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10
Q

air moves from low pressure to high pressure

true or false?

A

false

always high to low- down the gradient

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11
Q

PB

A

atmospheric pressure = Patm

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12
Q

PPL

A

plural space pressure

pressure of the bag around the lung

decrease in pressure (more negative)= inhale

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13
Q

diaphragm is innervated by the ___

A

phrenic nerve

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14
Q

what happens when the diaphragm contracts?

A

increases volume of the thorax

pulled down and pushes ribs out

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15
Q

External intercostal muscles aid in

A

inhalation (expand the thorax)

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16
Q

internal intercostal muscle aid in ___

A

expiration

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17
Q

quiet expiration is a ___process

A

passive (does not take energy)

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18
Q

___ muscles are accessory for inspiration and are recruited only during maximal inspiratory effort

A

scalene and sternocleidomastoid

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19
Q

abdominal muscles can be used for ___ if the lungs are stiff to ___

A

active exhalation

push the air out

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20
Q

lungs contain ___ making the lungs want to collapse ___

A

elastin

inward

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21
Q

the chest walls are springy and want to ___

A

recoil outward (expand)

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22
Q

what keeps the lung inflated and keeps the chest wall from pushing open?

A

negative pleural pressure

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23
Q

fluid in the pleural space does what?

A

allows the lungs and ribs to slide

keeps them stuck together (slides and water)

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24
Q

boyles law

A

P1V1=P2V2

volume and pressure are inversely related. as volume gets bigger pressure gets smaller (more negative) and vice versa

increase in volume =more negative pressure

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25
Q

by boyles law if you increase volume, what happens to pressure?

A

becomes more negative

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26
Q

more negative pressure within the alveolar causes ___

A

gas to flow into the alveoli (air goes high to low)

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27
Q

___ says pressure and volume are inverse to each other.

A

boyles law

as volume increases, pressure decreases

as volume decreases, pressure increases

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28
Q

PAW

A

airway pressure

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29
Q

PALV

A

alveolar pressure

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30
Q

PB

A

also PATM

atmospheric pressure= use 0 in most cases

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31
Q

PTP

A

transpulmonary pressure= pressure across the alveolar wall

PTP=PALV-PPL

transpulmonary pressure = alveolar pressure = pleural pressure

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32
Q

unit for pressure

A

cmH20

mmHg

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33
Q

the more negative your pleural pressure = ___ transpulmonary pressure

A

higher (bigger the difference between alveolar pressure and pleural pressure)

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34
Q

deep breathe, pleural pressure becomes ___

A

more negative

boyles law- increase in volume = decrease in pressure

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35
Q

when you relax and exhale, pleural pressure becomes ___

A

more positive

decrease in volume = increase in pressure

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36
Q

if you breathe in through coffee straw, pleural pressure will become extra ___

A

negative (have to pull really hard)

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37
Q

yellow arrows?

A

transpulmonary pressure:

= pressure across the alveolar wall

• PTP = PALV - PPL

pressure to keep alveolar open (wants to collapse this keeps them open)

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38
Q

blue arrows?

A

movement of air in or out of lungs

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39
Q

at peak inspiration what happens to Palv and Patm

A

equalized

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40
Q

when diaphragm relaxes, air is expelled passively from elastic recoil. What has happened to PPL?

A

increases (more positive)

decrease in volume= increase in pressure

pushed air out

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41
Q

negative PALV

A

air is being sucked into the lungs

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42
Q

PALV is positive =

A

air is being pushed out of the lungs

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43
Q

the harder it is to breathe in. what happens to PPL

A

becomes more negative- pulls in harder into the lungs

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44
Q

pneumothorax

A

loss of negative pleural pressure- air rushes into the pleural space when damage to ribs

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45
Q

what does this show?

A

pneumothorax

everything at zero. lung collapses, and ribs flare out

air does not move in or out of lungs

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46
Q

why is Ppl always slightly negative during normal breathing?

A

to keep lungs inflated and prevent ribs from flaring. hold everything together

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47
Q

when in the respiratory cycle is Ppl most negative?

A

peak inhale

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48
Q

what is PPL if you have an open chest wound?

A

0 same as the atmosphere. lung deflates, ribs expanded

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49
Q

How does a open chest wound affect breathing?

A

stops breathing, can’t change pressure, air wont go in or our of lung

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50
Q

how to know asthma medication working

A

asthma= small tube= needs bigger negative to inhale into lungs (-13)

meds= decrease in negative (more positive)= easier to get air into lungs (-8)

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51
Q

normal in and out breathing

A

tidal volume

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52
Q

total amount you can inhale

A

inspiratory capacity

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53
Q

total amount of air you can breathe out

A

expiratory reserve volume

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54
Q

total amount you can breathe in and out

A

vital capacity

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55
Q

amount of air left in your lungs after you exhale

A

residual volume

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56
Q

amount of extra air you can breathe in after tidal volume

A

inspiratory reserve volume

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57
Q

normal amount of air breathing in and out

A

tidal volume

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58
Q

total amount of air left in your lungs after breathing out normally

A

functional residual capacity

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59
Q

total amount of air you can breathe in and out and left in your lungs

A

total lung capacity

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60
Q
A

inspiratory reserve volume

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61
Q
A

vital capacity (biggest in and out)

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62
Q
A

tidal volume

normal breathing

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63
Q
A

functional residual capacity

amount left after regular breathing (shot in the head)

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64
Q
A

expiratory reserve volume

(biggest exhale possible)

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65
Q
A

residual volume

(dead space air that is always in the lungs)

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66
Q

what can’t spirometry measure?

A

residual volume

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67
Q

how to measure residual volume

A

plethysmography

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68
Q

___ is the volume of gas that can be contained within the maximally inflated lungs (average human = 6 L)

A

Total lung capacity (TLC)

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69
Q

___ is the volume of a single expired breath (10-20 ml/kg for animals; average human has 500 ml/breath)

A

Tidal volume (VT)

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70
Q

____is the maximal volume that can be expelled from the lungs after maximal inspiration (av. human = 4.5 L)

A

–Vital capacity (VC)

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71
Q

___ is the volume of gas that remains in the lungs after maximal expiration (av. human = 1.5 L)

A

Residual volume (RV)

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72
Q

–___ is the volume remaining in the lungs at the end of a normal tidal expiration (av. human = 3 L)

A

Functional residual capacity (FRC)

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73
Q

–If you just stop breathing at the end of a breath and relax (with an open glottis), your lungs will be at ___

A

functional residual capacity (FRC)

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74
Q

1.The lung tissue contains elastin, making the lung have a tendency to recoil ___________. The ribs are springy and recoil ___________.

A

in

out

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75
Q

The pleural space contains ____________. The pleural pressure is (almost) always ____________ in a normal animal.

A

fluid

negative

(keep lungs open)

76
Q

When the diaphragm contracts, the thoracic volume becomes __________, and due to Boyle’s law, therefore the intrathoracic pressure becomes more _________________.

A

bigger

negative (smaller)

77
Q

During inspiration, pleural pressure becomes more ______________, leading to the alveolar pressure becoming more _______________. Because atmospheric pressure is always constant, air moves ________ the alveolus and the alveolar pressure goes to _____________.

A

negative

negative

inward

equal=0

78
Q

If the pleural pressure is -5 cmH2O at FRC, which of these is it likely to be at TLC? (a) -5 (b) 0 (c) -10 (d) +5

A

-10

more negative= TLC→ total lung capacity

FRC→ functional residual capacity (left after exhale)

TLC is bigger, increase in volume = decrease in pressure = more negative

79
Q

During expiration, as the pleural pressure becomes less ___________, the alveolar pressure becomes _____________, causing air to __________ the lung.

A

negative

positive

leave (push out)

80
Q

If the pleural pressure is -5 cmH2O at FRC, which of these is
it likely to be at RV? (a) -5 (b) 0 (c) -10 (d) +5

A

+5

pleural pressure has to be equal and opposite to residual volume to keep lung inflated

81
Q

If you were paralyzed by a poison-tipped arrow, what would your lung volume be as you suffocated to death?

A

FRC functional residual capacity

82
Q

If you breathe in as much as you can and then breathe out as far as you can, what volume have you exhaled?

What volume is left in your lungs?

A

vital capacity

residual volume

83
Q

Why can you measure IRV with a spirometer but not FRC

A

can not measure residual volume therefore can not measure functional residual capacity

but can measure inspiratory reserve volume

84
Q

When you are breathing normally, what lung volume is each breath (the name, not the number of mls)?

A

total volume

85
Q

where do you start and finish

A

FRC (functional residual capacity)

TLC (total lung capacity)

86
Q

why is there a gap?

A

hysteresis

easier to deflate then to inflate

87
Q

hysteresis

A

easier to deflate then to inflate

gap in pressure volume curve

88
Q

compliance

A

change in lung volume/change in pleural pressure

how stretchy are the lungs

89
Q

why non linear?

A

stiffer as you start to get to TLC, compliance gets worse

ribs are in the way

90
Q

what sort of animals might have greater lung compliance?

A

foul- younger stretchy rib cage

91
Q

a chest bandage will have what effect on compliance

A

decreases- makes ribs less stretchy

92
Q

change in volume/ change in pressure

A

compliance = how stretchy lungs are

93
Q

loss of elastin is called ___ which will make compliance ___

A

emphysema

higher (lungs will not want to contract anymore- more holes= more stretchy)

94
Q

elastin into scar tissue is ___ and causes compliance to ___

A

fibrosis

decrease

(not as stretchy- thick water balloon vs thin water balloon)

95
Q

•The lung parenchyma is ___and will collapse if force is not applied to expand it

A

passive

96
Q

•Elastin within alveolar walls contributes to passive ___ of the lungs

A

deflation

97
Q

____ within the pulmonary interstitium resists further expansion at high lung volumes

A

•Collagen

98
Q

•If elastin is reduced, compliance gets ___

A

higher

(make lungs more stretchy, less things trying to make it collapse)

99
Q

which has the most compliance?

A

blue line, floppy balloon (emphysema)

100
Q

what represents fibrosis

A

stiff balloon= less compliant

101
Q

A saline filled lung has much greater compliance and a smaller hysteresis. Why? Saline abolishes ___

A

surface tension

102
Q

The pressure required to maintain alveoli in the open state is related to the ___ (T) and radius (r).

A

surface tension

103
Q

laplace law

A

pressure = (4 x surface tension)/radius

So small alveoli (small r) would collapse before big ones

harder to hold open tiny bubble then big bubble

104
Q

true or false

laplace law says it is easier to hold open a small bubble then a big bubble

A

false

small bubble would collapse before big one

P=(4 x surface tension)/radius

105
Q

____ is a phospholipid synthesized by Type II cells by lamellar inclusion bodies

A

pulmonary surfactant

106
Q

pulmonary surfactant reduces ___

A

surface tension, reducing pressure needed to keep alveoli open

107
Q

___ also allows surface tension to vary directly with radius, so it reduces the extra surface tension in smaller alveoli. So both small and large alveoli can exist

A

pulmonary Surfactant

108
Q

what happens in lungs of premature baby?

A

no surfactant = increase in surface tension

= more negative pressure needed to open alveoli→ ventilator turned up high → can lead to bursting alveoli if pressure too high

109
Q

•Alveolar walls and airway walls are structurally connected, and individual alveoli are prevented from isolated collapse by ___

A

“tethering“

110
Q

tethering in alveoli

A

if an alveolus or airway begins to collapse, tension on the walls (exerted through collagen fibers) from neighboring alveoli tend to hold it open.

111
Q

pulmonary edema will do what to compliance ?

A

decrease- make less stretchy/more stiff

112
Q

emphysema will do what ___

A

increase compliance by a loss of elastic tissue

lungs don’t want to collapse as hard

113
Q

loss of surfactant will do what to compliance?

A

decrease compliance (make less stretchy because it increases surface tension) (premature baby)

114
Q

floppy rib cage will ___ compliance

A

increase (more stretchy)

115
Q

chest bandage will do what to compliance?

A

decrease

(less stretchy)

116
Q
A

pulmonary fibrosis (scar tissue)

decrease in compliance (less stretchy)

117
Q
A

emphysema

loss elastin

more compliant (more stretchy) thin balloon

118
Q
A

atelectasis

collapsed alveoli (baby not enough surfactant)

decrease compliance (increase surface tension)

119
Q

alveoli collapse

A

atelectasis

baby no surfactant (decrease compliance -less stretchy- more stiff)

120
Q

a fibrosis lung will have a lower TLC then an emphysema lung.

true or false?

A

true

fibrosis= less compliance = not as stretchy

121
Q

An atelectic lung has ___compliance, and is therefore harder to ventilate and easier to damage with high ventilator settings

A

lower

(less stretchy/more stiff)

122
Q

-What happens to lung compliance under anesthesia in the control group?

A

control = ZEEP= green

compliance decreases= harder to ventilate as the procedure continues

123
Q

true or false

emphysema will have smaller residual volume then fibrosis

A

false

emphysema= more compliant= big holes= more dead space= more RV left in the lung

124
Q

true or false pulmonary fibrosis will have a smaller TLC then a normal lung

A

true

not as stretchy= decreased complaince= smaller total lung capacity

125
Q

what do you think the lung volumes will be in a patient with atelectasis?

A

decreased RV?- collapsed alveoli= less dead space

???

126
Q

•For a particular lung/chest wall, at a specific pressure, the volume will ___, whether that pressure is generate by a change in PPL or by positive pressure ventilation (a ventilator)

A

be the same

127
Q

•Static ___ is measured during a pause in respiration, while there is no airflow

A

compliance

128
Q

= ∆V/∆P

A

complaince

129
Q

how to graph compliance

A

pressure-volume curve

130
Q

A smoker develops emphysema. When they take a deep breath, their lungs expand from an FRC of 800ml with a pleural pressure of -4cmH2O to a TLC of 2500 ml and a PPL of -8cmH2O. What is their static compliance?

A

change in volume/change in pressure

(2500-800)/(8-4)

1700/4

425

131
Q

A smoker develops emphysema. When they take a deep breath, their lungs
expand from an FRC of 800ml with a pleural pressure of -4cmH2O to a TLC of 2500 ml and a PPL of -8cmH2O.

Draw a pressure-volume curve illustrating your answer. Label the axes with numbers and show your work.

A
132
Q

if emphysema has worsened. would compliance be higher or lower?

A

higher/steeper

more complaint

133
Q

P-V curve expiration and inspiration

A
134
Q

What is the ΔPPL needed to reach TLC in the baby, before and after the surfactant (qualitative answer)?

A

before surfactant= decrease in compliance= harder to breathe in= greater change in Ppl needed

after surfactant = increased compliance

135
Q

Why might generating very high ΔPPL for several days be a
difficult for a baby?

A

alveoli would burst, babies are less musculature and would get tired from the increased effort

136
Q

Draw a P-V curve for a patient with a bilateral pneumothorax

A

dot

can not breathe in or out

no change in pressure or change in volume

137
Q

compliance after tight chest bandage

A

bandage= less compliant= stiff

138
Q

why are the alveoli at the top of the lung bigger?

A

gravity

139
Q

what is this showing?

A

at increased pressure all alveoli are open

at decrease pressure alveoli on the bottom are closed due to gravity

140
Q

Because of gravity and the weight of the lung, the pleural pressure is ___ at the base than at the apex

A

less negative

141
Q

regional difference of compliance and ventilation at FRC

A

base: higher compliance because alveoli are open but have lots of room

142
Q

regional difference of compliance and ventilation at FRC

A

apex= compliance drops because alveoli are almost full

(balloon fully blown up- any bigger would explode)

143
Q

When you forcefully exhale all the way to RV, the pressure at the base actually ____ airway (atmospheric) pressure. As a consequence, airways collapse and no gas enters with small inspirations (diaphragm movements)

A

exceeds (becomes +)

144
Q

at RV, the base of the lung will have ___ compliance compared to the top of the lung

A

decreased (base of lung goes to +, alveoli smooshed closed→ harder to inflate)

where at the apex of the lung- compliance would be better because alveoli have some air but lots of room before they reach TLC

145
Q

___= change in pressure/flow

A

resistance

146
Q

units for resistance

A

change in pressure/flow

cmH20/L/s

147
Q

resistance is dependent on ___

A
  • Laminar versus turbulent flow
  • Radius of tube (narrow airway)
  • Length of tube (short straw vs. long straw)
  • Lung volume (tethering)

Viscosity of gas/liquid (divers breathe helium

148
Q

in conducting airways, gas move by ___

A

laminar flow (150ml)

149
Q

in the respiratory zone, air moves by ___

A

diffusion because the volume is so much bigger (150 compared to 3000ml)

150
Q

what happens to the area of airways

A

respiratory zone has drastic increase in SA→ air moves by diffusion instead of laminar flow

151
Q

why is flow faster in the upper airways?

A

need to keep up with the respiratory airways. a bunch of lanes merging into one, needed to go faster to keep up

•In the lungs, thousands and thousand of bronchioles merging into the larger bronchi and trachea – the flow rate of air must get faster with every merge

152
Q

ohm’s law

A

R= change in pressure/change in flow

153
Q

where is most of the resistance in airways?

A

upper airway (nasal passages, larynx, trachea, large bronchi)

in healthy animal only 20% of resistance airways are in the small airways

154
Q
A

ohms law

change in pressure/ flow

155
Q

hagen-poiseuille equation

A

The Hagen–Poiseuille equation is a physical law that gives the pressure drop in a fluid flowing through a long cylindrical pipe.

  • the flow rate of the gas (airflow, here)
  • the length of the pipe
  • the dynamic viscosity of the fluid
  • especially the radius of the tube (r4; radius to the fourth power!)
156
Q

based on hagen poiseuille equation what effects resistance the most?

A

radius

157
Q

•How do we decrease our airway resistance during exercise?

A

increase radius (poiseuille’s equation R=1/r4

make glottic cleft larger

158
Q

what happens to resistance when radius goes from 1 to 0.5?

A

increases by 16 times!

159
Q

During an asthma attack, the smooth muscles of the small airways constrict (___) and get plugged with mucus and pus.

A

bronchoconstriction

160
Q

•Small terminal airways have the highest ___resistance

A

individual

  • but total resistance for all these airways together is less than that of the medium sized airways, because resistances in parallel sum as reciprocals (like electricity)
  • The greatest resistance is actually in airway generations >2mm diameter
161
Q

•The greatest resistance is actually in airway ___ diameter

A

generations >2mm

162
Q

Smaller airways do not have cartilaginous support, and are easily distended or compressed as the lungs inflate and deflate. As lungs inflate, the smaller airways dilate from radial traction from the alveoli, which ___ resistance during inspiration

A

reduces

163
Q

Bulk air flow may be turbulent or laminar depending on velocity, airway diameter and airway branching. ___ has less resistance; where flow becomes ___ there is greater resistance.

A

Laminar flow

turbulent

164
Q

how to measure change in pleural pressure

A

esophageal balloon

•We measure pleural pressure (PPL) with an esophageal balloon (cmH2O)

165
Q

•We measure ___with a pneumotachnograph attached to a mask (L/s)

A

airflow ( V (dot) )

166
Q

where is inspiration?

A
167
Q

would you give oral or nebulisation?

A

oral

want resistance to decrease= want it easier to breathe

168
Q

You are examining a horse with asthma. You place an esophageal balloon and a pneumotachnograph. What does each of these measure? Units?

A

pleural pressure

cmH20

169
Q

During tidal breathing, the PPL measurements vacillate from -5cmH2O to -35cmH2O.
Which of these pressure values is associated with maximum inspiration?

A

-35

more negative= inhale

170
Q

During tidal breathing, the PPL measurements vacillate from -5cmH2O to -35cmH2O.

If the flow rate during tidal breathing is 10 L/s, what is his pulmonary resistance (RL)?

A

R= change in pressure/ change in flow

(35-5)/(10)

3.5 cmH20/L/s

171
Q

You administer atropine, and the RL changes from 3.5 to 1 cmH2O/L/s. Which component of resistance do you think it affected?

A

increased flow rate

or

change in pressure

Poiseuille equation: things that effect resistance: the flow rate of the gas (airflow, here) • the length of the pipe • the dynamic viscosity of the fluid • especially the radius of the tube (r4; radius to the fourth power!)

172
Q

You see a racehorse for laryngeal hemiplegia. The left arytenoid shows minimal abduction during exercising endoscopy. If you do a tie-back surgery and increase its laryngeal aperture radius from 5cm to 10cm, what effect will that have on resistance, quantitatively?

A

decrease resistance by a factor of 16

Poiseuille Equation

R= 1/radius4

173
Q

What other factors beyond radius affect resistance?

A

the flow rate of the gas (airflow, here)

  • the length of the pipe
  • the dynamic viscosity of the fluid
  • radius of the tube (r4; radius to the fourth power!)

Hagen–Poiseuille equation

174
Q

if you measured the max change in Ppl in this racehorse during max exercise before and after the tie back, what difference would you expect to see?

A

change in PPl would decrease, less effort to breathe → less pleural pressure = less negative

175
Q

this westie has a very low TLC. his lung compliance is very low. what disease does he have?

A

pulmonary fibrosis (very stiff lung)

176
Q

The Pekinese has a slightly increased TLC but a huge RV. His lung
compliance is very high. What disease does he have?

A

emphysema

no elastin- floppy lungs- too stretchy

177
Q

The bulldog has incredibly high airway resistance (R What is the root cause? What would happen to his resistance if he was intubated?

A

upper airway resistance

brachiocephalic upper airway

intubation would make it better.

178
Q

what happens if you intubate pulmonary fibrosis paitent?

A

nothing, issue with alveoli, tube in throat will not help

179
Q

___ is how hard to move air through a tube

A

resistance

180
Q

___ is how stretchy/elastic is the lung

A

compliance

181
Q

change in volume is inverse to change in pressure

A

boyles law

182
Q

pressure volume curves measure what

A

compliance

183
Q

change in pressure/ change in flow

A

ohm’s law

184
Q

what disease change resistance in lower airways

A

asthma

decrease in radius of the bronchioles will increase resistance by factor of 16

185
Q

flow volume loops for asthma and emphysema

A

harder to expire

I n animals that have a pulmonary obstructive disease (obstruction in the lung, not the upper airway), air from the large airways can be expired without problems so at the beginning of the expiration, flow is normal.

With asthma, the small airways are narrowed so in the last part of expiration the air will come out slower (you can simulate this by blowing out through a straw), shown by the flattening of the curve. Likewise, with emphysema, gas is trapped in the huge pockets and therefor it can’t be exhaled (“gas trapping”, high residual volume)

Flow-volume: loop is concave, FVC normal, expiration is harder

186
Q
A

flow volume loop for fibrosis

Restrictive lung disease means that the lungs can’t expand, either due to scar tissue in the parenchyma (fibrosis) or an extrathoracic restriction (a tight chest bandage), so the total lung capacity (TLC) is low. Although an accurate diagnoses of total lung volume is not possible with spirometry (residual lung volume cannot be measured with a spirometer) flow-volume results can be very suggestive for a restrictive lung disease. Total lung volume is low, which results in a low (forced)VC.

Flow-volume loop: shape normal, FVC low, inspiration is harder

22 spring: Physiology (34 decks)

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