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A&P II > Exam III- Spring 2024 > Flashcards

Exam III- Spring 2024 Flashcards

1
Q

What is the formula to calculate Transpulmonary Pressures (PTP)? What other pressure does this formula work for?

A
  • PTP= Aveolar Pressure (PA) - Pleural Pressure (PIP)
  • Elastic Pressure (PEL)
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2
Q

What is the formula for Tidal Volume?
What is the formula in minute ventilation?
What are the normal values for each?

A
  • VT= VDS + VA
  • Minute Vent= VT x (RR)
  • Resp. Rate= 12 bpm
  • Tidal Volume= 500 mL; 6 L/min
  • Dead Space Volume= 150 mL; 1.8 L/ min
  • Aveolar Volume= 350 mL; 4.2 L/ min
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3
Q

What are the normal volumes for:

Tidal Volume
Residual Volume
Expiratory Reserve Volume
Inspiratory Reserve Volume

A
  • TV= 500 mL
  • RV= 1.5 L
  • ERV= 1.5 L
  • IRV= 2.5 L
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4
Q

Which volumes make up the following capacities and their normal values:

Total Lung Capacity
Inspiratory Capacity
Functional Residual Capacity
Working/ Vital Capacity

A
  • TLC= 6 L
  • IC= IRV+VT= 3.0 L
  • FRC= ERV+RV= 3.0 L
  • VC= IRV+VT+ERV= 4.5 L
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5
Q

PA>Pv>Pa

A
  • West Perfusion Zone 1
  • no blood flow
  • In a healthy lung, there should not be a zone 1
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6
Q

Pa>PA>Pv

A
  • West Perfusion Zone 2
  • Pulsatile flow; “In between”
  • Pulsatile blood flow during higer pressures times of the cardiac cycle and tapers off with a lower pulm blood pressure
  • top portions of the lung
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7
Q

Pa>Pv>PA

A
  • West Perfusion Zone 3
  • Continuous flow; “always on”
  • Normally in the bottom 1/2 of the lung
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8
Q

The effects of the weight of the lung on blood flow at the very base of the lung that sits on the diaphragm

A
  • West Perfusion Zone 4
  • A subset of Zone 3; reduces the amount of blood flow in the very bottom portion of the base
  • the weight of the lungs compress the easily collapsable pulm vein and arteries
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9
Q

When does cyanosis occur as it pertains to deoxyhemoglobin?

A

When deoxyhemoglobin >5 g/ dL

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10
Q

What is the Fick Equation for C.O.?

A

CO= O2 absorbed per min (mL/ min)/ Arteriovenous O2 difference (ml/ L)

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11
Q

What is Guyton’s formula for calculating PVR?
What is normal?

A

PVR= MPAP-LAP/ C.O.

Normal= .14 PRU

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12
Q

What is Miller’s Formula for calculating PVR?
What is normal?

A

PVR= MPAP- PAWP/ C.O. (x 80 converts units to CGS)
Normal= 96 mmHg/L/min

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13
Q

What is a CGS?
What are its units?
What is the equivalent PRU?

A
  • Centimeters Gram Second
  • mmHg/ L/ min or dyne x sec/ cm^5
  • 1 CGS= 1333 x PRU
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14
Q

What volumes make up the vital capacity?

A

Expiratory Reserve Volume (ERV), Tidal Volume (TV), and Inspiratory Reserve Volume (IRV)

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15
Q

What volumes make up functional residual capacity (FRC)?

A

ERV, RV

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16
Q

Alveolar resistance gets higher ___ , gets lower ___

A

Lung volumes get higer; as lung volume gets lower

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17
Q

The higher the pulmonary blood flow, the lower the ______.

A

PVR

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18
Q

What are the two ways that our body reduces PVR when C.O. increases?

A

Recruitment and distension

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19
Q

What happens with right heart failure?

A

With decreased C.O., lungs decruit and vessels narrow, increasing PVR, increasing afterload for RH

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20
Q

What would increase PVR?

A
  • Decreased/ Increased lung volume (above FRC)
  • Decreased RH C.O.
  • PPV
  • Loss of alveoli
  • Increased Interstitial pressure
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21
Q

What would decrease PVR?

A
  • Increased C.O.
  • Increased PAP
  • Increased LAP
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22
Q

What are the pulmonary capillary pressures?

A
  • Pc= 7 mmHg
  • ∏p= 28 mmHg
  • Pic= -8 mmHg
  • ∏if= 14 mmHg
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23
Q

What is the formula for calculating net filtration and net flow?

A
  • Net filtration= Pc-Pif-∏p+∏if
  • Net flow= Kf x (Pc-Pif) - (∏p-∏if)
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24
Q

HPV is primarily an effect of what gas?

A

Primarily O2; secondarily CO2

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25
2/3 of lungs elastic recoil pressure is ____ ____ and 1/3 is from the ____ itself. Which is more important?
Surface tension; Tissue The behavior of the tissue is most important because as long as the lungs are healthy, there should always be enough surfactant.
26
Top of lung doesnt get emptier than ? Bottom lung doesn’t get emptier than ?
Top: 30% Bottom: 20%
27
FRC intrapleural pressure: RV intrapleural pressure:
FRC: -5 cm H2O (-8.5; -1.5) RV: +2 cm H2O (-2.2; +4.8)
28
Functions of Club Cells
* Found in the bronchioles, produces surfactant at much lower rate than alveoli type II cells * Progenitor cell for damaged areas of lungs
29
Type 1 and Type 2 alveolar cell percentage
* Type 1: 90-95% of alveolar surface area * Type 2: 5-10% of alveolar surface area
30
Increasing lung volume does what to PVR? Why?
Increases At very high lung volumes Total PVR is elevated because **Alveolar resistance** is elevated
31
Decreasing lung volume does what to PVR? Why?
Increases At very low lung volumes Total PVR is elevated because **extraalveolar resistance** is elevated
32
Decreasing lung volume does what to airway resistance?
Decreases
33
FRC volumes standing v supine
Standing- 3 L Supine- 2 L
34
FRC drops in supine pt because of?
reduction in ERV *“...diaphragm is getting pushed up from all the mass of the stuff that’s in your abdomen. So the volume that gets squeezed out is the ERV. “*
35
What is the normal airway compliance value for the lungs?
200 mL/ per cm H20
36
____% of expired air should be CO2
5%
37
At what transpulmonary pressure is TLC?
25-30 cm H2O
38
What are the effects on volumes and capacities with **Restrictive Lung Disease**?
* Decrease: RV, ERV, TV, VC, FRC, and TLC * IRV may be low to normal depending on how the stage of disease
39
What are the effects on volumes and capacties with **Obstructive Lung Disease**?
* Large increase in TLC * Increase RV --> decrease in ERV and IRV * VC decreases and is almost equal to TLC as the disease worsens
40
Which of the following conditions are reasonable explanations for a patient’s **decreased static pulmonary compliance** (the pressure-volume curve for the lungs shifted to the right)?
* Decreased functional pulmonary surfactant * Fibrosis of the lungs * Surgical removal of one lobe * Pulmonary vascular congestion
41
Which of the following tend to increase airways resistance?
* Stimulation of the parasympathetic postganglionic fibers innervating the bronchial and bronchiolar smooth muscle * Low lung volumes * Forced expirations * Breathing through the nose instead of the mouth
42
Which of the following statements concerning alveolar pressure is/are correct?
a. Alveolar pressure is lower than atmospheric pressure during a normal negative-pressure inspiration. b. Alveolar pressure is greater than atmospheric pressure during a forced expiration. c. Alveolar pressure equals the sum of the intrapleural pressure plus the alveolar elastic recoil pressure. d. Alveolar pressure equals atmospheric pressure at the end of a normal tidal expiration.
43
True statements concerning small airways
* The total resistance to airflow decreases with successive generations of airways because there are increasing numbers of units arranged in parallel. * The linear velocity of airflow decreases as the airways decrease in size because their total cross-sectional area increases. * Alveolar elastic recoil plays an important role in determining the resistance to airflow in small airways because alveolar septal traction helps to oppose dynamic compression. * Airflow in small airways is usually laminar.
44
Compliance Formula
∆V/∆P
45
____ meaures how hard it is to get current through this circuit ____ measures how easy it is to get current through this circuit
* Resistance * Conductance
46
Easy way to calculate anatomical dead space
* 1 mL/ lb of body mass
47
What is the time for a normal healthy person to dilute their N2 concentration to ____ %?
* 2.5% with 7 minutes of breathing
48
Nitrogen Washout Which lung disease has an increased time for N2 washout? Which may be normal ?
* Obstructive Lung Disease * Restrictive Lung Disease
49
What is the main difference between Closing Volume/ Capacity test and Fowler's test?
Closing volume/ capacity looks at a breath from TLC to RV and Fowler's only looks at Vt.
50
What is Phase I of the CVC?
* No N2 coming out; similar to 1st part of Fowler's * Air from anatomical dead space
51
What is Phase II of the CVC?
* Rapid upstroke of N2 * Transitional phase; similar to Fowler's * Air from alveoli and respiratory bronchioles
52
What is Phase III of the CVC?
* Plateau Phase; smiliar to Fowler's * Air is coming different places within the system
53
What is Phase IV of the CVC?
* Closing Volume * The result of small airways at the base of the lungs collapsing
54
What is the FEV:FVC? Disease?
3.8 L/ 5 L= about 76% Probably a healthy person
55
What is the FEV:FVC? Disease?
2.5 L/ 3 L= about 83% Likely Restrictive Lung Disease
56
What is the FEV:FVC? Disease?
1.75 L/ 2 L= about 87% Likely Restrictive Lung Disease
57
What is the FEV:FVC? Disease?
* Higher ratio- FEV1 1.5 L/ * Definitely Obstructive Lung Disease *Takes up to 10 secs to expire all the air
58
What are the FEV1, FVC, Ratio, TLC, RV, FRC for: Asthma
* FEV1-decreased * FVC- decreased * Ratio- decreased * TLC- Normal to increased * RV- increased * FRC- Normal to increased
59
What are the FEV1, FVC, Ratio, TLC, RV FRC for: COPD
* FEV1-decreased * FVC- normal to decreased * Ratio- decreased * TLC- Normal to increased * RV- increased * FRC- Normal to increased
60
What are the FEV1, FVC, Ratio, TLC, RV, FRC for: Fibrosis
* FEV1-decreased * FVC- decreased * Ratio- normal to increased * TLC- decreased * RV- decreased * FRC- decreased
61
What are the FEV1, FVC, Ratio, TLC, RV FRC for: Muscle Weakness
* FEV1-decreased * FVC- decreased * Ratio- normal to increased * TLC- Normal to increased * RV- Normal to increased * FRC- Normal
62
What are the FEV1, FVC, Ratio, TLC, RV, FRC for: Kyphoscoliosis
* FEV1-decreased * FVC- decreased * Ratio- Normal to increased * TLC- decreased * RV- normal to decreased * FRC- decreased
63
What is the normal value for PO2 in 1 mL of blood? What about per dL?
* 0.00003 mL O2/ mmHg/ mL of blood * 0.003 dL O2/ mmHg/ dL of blood
64
How many mL O2 are in arterial and venous blood, respectively?
* 0.3 mL O2/ dL * 0.12 mL O2/ dL
65
Normal value for hemoglobin?
15 g/ dL *women will be lower
66
What is the normal carrying capacity of O2?
* 1.34 mL O2
67
What is the normal amount of O2 in a dL of blood (assuming 100% saturation of Hb)?
20.1 mL O2/ dL blood
68
What are two reasons we don't normally have 100% saturation?
* Methemoglobin * Bronchiolar admixture
69
What can shift O2 Curve left (either comparatively or clinically)?
* HbF- higher affinity * HbCO - higher affinity * ↓ CO2 (Bohr)/ ↑ pH/ ↓H+ * ↓ 2,3-BPG * ↓ temp *hypthermia may not cause a shift because tissue metabolism decreases also
70
What can shift O2 Curve right (either comparatively or clinically)?
* ↑CO2 (Bohr)/↓ pH/ ↑H+ * ↑ 2,3- BPG * ↑ temp * Anemia
71
Fetal Hb is very similar to ?
* Myoglobin
72
What is the normal range of Hb saturation coming back from the tissues? Leaving the lungs?
* About 20%-75% * 90%-100% (duh Mebin)
73
What are all the names for 2,3-BPG?
* 2,3 Bisphosphoglycerate * 2,3 Diphosphoglycerate * Bisphosphoglyceric Acid
74
What is the P50 dependent on?
* Hb affinity for O2
75
What are the two forms of O2 and their respective amounts? Total?
* Dissolve O2: 0.3 mL * Bound O2: 20 mL * Total= 20.3
76
What are the different forms of CO2? Total?
* Bicarb/ carbonic acid- 90% or 43.2 mL CO2/ dL blood * Dissolved- 5% or 2.4 mL CO2/ dL blood * Carbamino Compound- 5% or 2.4 mL CO2/ dL blood *Total is 48 mL CO2/ dL for CaCO2
77
What is the normal value for PCO2 in 1 mL of solution? What about per dL?
* 0.0006 mL CO2/ mmHg/ mL * 0.06 mL CO2/ mmHg/ dL *CO2 is 20x more soluble than O2
78
What is the normal CaCO2 and CvCO2?
* 48 mL CO2/ dL blood * 52.5 mL CO2/ dL blood *difference is 4.5 mL CO2
79
In exhange for the ____ mL O2/ dL blood we drop off ____ mL CO2/ dL blood
5; 4.5
80
Normal CO2 production (exchange) per minute?
* 4.5 ml CO2/ dL blood x 50 dL blood/ min= **225 mL CO2/ min** *we drop off 250 mL O2 and pick up 225 mL CO2 each minute
81
What is diffusivity depedent on? Formula?
* Solubility of the gas and molecular weight of the molecule * D= Solubility/(√Molecular Wt)
82
How do you determine the minute ventilation of a gas?
Fick's Law
83
Other conditions that would decrease FRC
* 3rd Trimester Pregnancy * Obesity
84
Changes in Vol. and Capactities when changing from supine to upright? * FRC, RV, ERV, TLC, VT, IRV, IC, VC
* FRC- ↑ * RV- No change * ERV- ↑ * TLC- No change or slight ↑ * VT- No change * IRV- ↓ * IC- ↓ * VC- No change
85
Situations that decrease PVR?
* Moderate Exercise
86
Situations that lead to an increased amount of West Zone 1
* Blood loss secondary to trauma * PPV with PEEP
87
Circumstances that contribute to pulm. edema
* Overtransfusion with saline * Occulstion of lymph drainage of an area in the lung * LV failure * Low plasma concentration * Destruction of portions of the pulmonary capillary endothelium by toxins
88
Situations that would occur with a partial occlusion of right main-stem bronchus
* R-lung PAO2↓ and PACO2 ↑ than L-lung * ↑ VQ ratio * ↓PO2
89
Lying on right side, R-lung will expect (compared to L-lung):
* ↓ PAO2 and ↑ PACO2 * ↑ blood flow per unit volume * ↑ ventilation per unit volume
90
Conditions to expect the diffusing capacity (DL) of lungs a. supine to upright b. exercise c. valsalva maneuver d. anemia e. ↓CO d/t blood loss f. diffuse interstitial fibrosis of lungs g. Emphysema
a. supine to upright- ↓ b. exercise- ↑ c. valsalva maneuver- ↓ d. anemia- ↓ e. ↓CO d/t blood loss- ↓ f. diffuse interstitial fibrosis- ↓ g. Emphysema- ↓
91
Hb loss from 15 to 12, expect a decrease in:
* Blood O2-carrying capacity * Arterial O2 content
92
Which would increase P50? a. Hypercapnia b. Acidosis c. ↑ 2,3-BPG d. ↑ body temp
ALL
93
PFTs consistent with?
Obstructive Lung Disease
94
Dynamic lung volumes not improved with bronchodilator. Likely disease?
COPD, primarily emphysema
95
PFTs consistent with?
Restrictive Lung Disease
96
Voluntary apnea for 90 secs will:
* ↑ PCO2 * ↓PO2 * stimulate arterial chemorecptors * stimulate central chemoreceptors
97
Occurs in an untrained athlete during exercise?
* ↓ PVR * ↑ CO * ↑ homogenous VQ ratios * ↑ diffusing capacity
98
a,b,c,d
99
a and b
100
a,c,d,e
101
Graham's Law
Compares one gas to another MW
102
Henry's Law
* Movement of a gas into a solution is dependent on ∆P and solubility
103
How many scalene muscles are there and where are the attachment points?
* 3 Scalene Muscles * 5: Anterior; C3-C6 and attach to Rib 1 * 6: Middle; C3-C7 and attach to Rib 1 * 7: Posterior; C5-C7 and attach to Rib 2
104
What are the three openings and their orientation in the body?
* Caval Aperture- most anterior * Aortic Aperture- most posterior * Esphogeal Aperture- between the two
105
What makes up 62% of all surfactant's phospholipids?
Unsaturated Phosphatidylcholine and Dipalmitoyl Phosphatidylcholine
106
Hydrophobic surfact protein
SP-B and SP-C
107
Surfactant make up % between protein and lipids
90% lipid, 10% protein

A&P II (5 decks)

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