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24 A&P II > Lecture 11 & 12: Pulmonary (Exam II) > Flashcards

Lecture 11 & 12: Pulmonary (Exam II) Flashcards

1
Q

What is normal alveolar ventilation (V̇A) ?
How is it calculated?

A
  • 4.2 L/min
  • VA x resp rate = V̇A
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2
Q

What is the highest that PAO₂ can be at room air O₂ concentrations at normal atmospheric pressure? Why?

A
  • 150mmHg
  • Cannot be higher than 150mmHg due to this being the oxygen concentration of the air.
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3
Q

What is the lowest that PAO₂ can be (and still have life)?

A

40mmHg

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4
Q

What could cause a left shift on the PAO₂ curve below?

A
  • ↓ V̇A
  • ↑ metabolism
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5
Q

What could cause a right shift on the PAO₂ curve below?

A
  • ↑ V̇A
  • ↓ metabolism
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6
Q

A decrease in V̇A would cause a __________ in PACO₂.

A

Increase

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7
Q

An increase in V̇A would cause a __________ in PACO₂.

A

decrease

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8
Q

What is the percentage of O₂ in a humidified inspiration?

A

19.69%

↓

149.7 ÷ 760 = 19.69%

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9
Q

How much of of an VA inspiration is O₂?

A
  • 68.9 mL O₂

350mL x [0.1969] = 68.915 mL O₂

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10
Q

How much of VA O₂ (in mLs) leaves per exhaled breath?

Assume PAO₂ = 104mmHg

A

PAO₂ after equilibrium = 104mmHg
↓
104mmHg ÷ 760mmHg = 0.1368 O₂ content.
↓
350mLO₂ x 0.1368 = 47.88 mLO₂
=
47.88 mL O₂ is unabsorbed with each breath.

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11
Q

How much of VA O₂ (in mLs) is absorbed per breath?

Assume PAO₂ = 104mmHg

A

Total inspired O₂ per breath = 68.915 mLO₂
↓
Total expired O₂ per breath = 47.88 mL O₂
↓
68.915 - 47.88 mLO₂ = 21.035 mLO₂ absorbed per breath.

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12
Q

How much total O₂ is exhaled per breath?

A

VA = 350mL
VD = 150mL
↓
350mL x 0.1368[O₂] = 47.88mLO₂
+
150mL x 0.1969[O₂] = 29.54mLO₂
↓
= 77.42 is the total O₂ (both VA and VD) expired per breath.

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13
Q

How much CO₂ is exhaled per minute?

Assume the patient has a respiratory rate of 12bpm and give your answer in liters.

A

PACO₂ = 40mmHg
↓
VD CO₂ content = 0
+
VA CO₂ = 40mmHg ÷ 760mmHg = .0526
↓
350mL x 0.0526[CO₂] = 18.42mLCO₂
↓
18.42mLCO₂ x 12bpm = 0.221 Liters of CO₂ per minute.

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14
Q

What is the compliance of the lungs based on graph below?

A

ΔV / ΔP = Compliance
0.5L / 2.5cmH₂O = 0.2L/cmH₂O

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15
Q

What is normal lung compliance?

A

0.2 L/cmH₂O

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16
Q

An increase of 1cmH₂O in pulmonary compliance creates an increase in pulmonary volume by _________.

Assume normal physiology

A

200mLs

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17
Q

A decrease in pulmonary compliance by 2 cmH₂O results in a ________ in pulmonary volume by _________mls.

Assume normal physiology.

A

decrease: 400mLs

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18
Q

What occurs with very small airways in the lungs when we have low lung volumes?

A

Small airways can collapse

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19
Q

What lung volumes can normal spirometry not measure?

A

Residual Volume (RV) and thus FRC and TLC as well.

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20
Q

How can FRC be measured utilizing spirometry?

A

Helium spirometry.

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21
Q

Suppose you had a spirometer of 10L with a Helium concentration of 10%.

After being attached to a patient and a respiratory cycle, the helium concentration becomes 8%.

What is the patient’s FRC?

A

1L He starting out
↓
0.08 * x = 1L He
↓
x = 12.5 (new total volume)
↓
12.5 - 10 = 2.5L = FRC

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22
Q

What is the 2nd leading cause of lung cancer?

A

Radon

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23
Q

What would occur with the elasticity of lung tissue with emphysematous lungs?

A

↓ PER

Therefore, more compliant.

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24
Q

What would occur with the elasticity of lung tissue with fibrotic lungs?

A

↑ PER

Therefore, less compliant.

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25
What would occur with alveolar size in fibrotic lungs? Why?
Alveolar size would decrease due to excessive PER.
26
What would occur with alveolar size in emphysematous lungs? Why?
Alveolar size would increase due to loss of PER.
27
Would total lung capacity (TLC) be increased or decreased (compared to normal lungs) at 30 cmH₂O in fibrotic lungs?
TLC would be decreased
28
Would total lung capacity (TLC) be increased or decreased (compared to normal lungs) at 30 cmH₂O in emphysematous lungs?
TLC would be increased
29
What pulmonary pressure works against PER?
PIP
30
What are the two components affecting lung PER and compliance? Which one has the greater effect?
1. Surface Tension (⅔ of PER) 2. Tissue Elasticity (⅓ of PER) *PER or compliance? or both?*
31
Why is there such a difference in the pulmonary compliance of an air-filled vs a saline-filled lung?
There is a no air-water interfaces and thus no of surface tension in the saline filled lung.
32
At what pressures is the lung most compliant during inspiration?
~ 9-16 cmH₂O
33
At what pressures is the lung least compliant during inspiration? Why is this?
~ 0-8 cmH₂O Lack of surfactant could be the cause of this period of non-compliance.
34
What term describes the change in lung behavior seen between inspiration and expiration?
Hysteresis
35
What substance counteracts the air-water interface surface tension?
Surfactant
36
What type of cell produces surfactant?
Type II cuboidal alveolar cells
37
What type of cell participates in gas exchange?
Type I alveolar cells
38
Which of the lung capacity figures below is indicative of obstructive disease? Why?
Trapping of air noted by the massively increased RV.
39
Which of the lung capacity figures below is indicative of restrictive disease? Why?
All lung volumes are decreased with no noted air trapping as seen with obstructive disease.
40
Which surfactant protein molecules are hydrophilic? Which are hydrophobic?
- Hydrophilic: A & D - Hydrophobic: B & C
41
What molecule forms the basis for most pulmonary surfactants?
Phosphatidylcholine
42
All lung pathologies feature a deficiency in __________.
surfactant
43
What composes surfactant?
Lipids (90%) Proteins (10%)
44
What do the surfactant lipids do?
- Lower surface tension - Limit lymphocyte cytotoxicity.
45
What do the surfactant proteins do?
- Enhance chemotaxis & phagocytosis. - Aggregate & opsonize micro-organisms. - Inhibit bacterial growth.
46
A strong IC is indicative of what?
Good lungs *A poor IC is highly correlated with bad lungs*.
47
What prevents autodigestion of the lungs via proteases?
- α1AT (α-1 Antitrypsin)
48
How can EtOH abuse lead to damaged lungs?
The liver produces α1-AT, without this molecule, the lungs will undergo proteolysis.
49
What sort of pathology is seen from a lack of α1-AT?
Emphysema - Lack of small alveoli - Any alveoli left are distended and dysfunctional
50
What cells package surfactant for release into the air-water interface?
Lamellar bodies
51
What are the two components that make up a V/Q ratio?
V̇A = 4.2L/min Q = 5L/min
52
What is a normal V/Q ratio?
V/Q = 4.2/5 = **0.8**
53
What would a V/Q of 0 indicate?
0/5 so there is **no airflow**. Perfusion is occurring with no ventilation. Likely an **airway obstruction**.
54
What would a V/Q of ∞ indicate?
4.2/0 so there is **no blood flow**. Ventilation is occurring with no perfusion. Likely something like a **pulmonary artery embolus**.
55
What would PACO₂ and PAO₂ be in the event of a pulmonary embolus? Why?
PAO₂ = 150mmHg PACO₂ = 0 mmHg No change in either number from room air due to no gas exchange occurring.
56
What would PACO₂ and PAO₂ be in the event of an acute airway obstruction? Why?
PAO₂ = 40mmHg PACO₂ = 45 mmHg No change in either number from returning mixed venous blood due to no fresh air reaching the alveolus.
57
In normal physiology, an increased V/Q ratio would be seen at the _____ of the lungs.
Apex
58
In normal physiology, a decreased V/Q ratio would be seen at the _____ of the lungs.
Base
59
V/Q matching tends to _______ as we get older.
decrease
60
Anesthesia will induce _____ lung volumes
low
61
What change occurred between these two graphics?
Artificial PEEP was introduced to improve V/Q matching by increasing V̇A.

24 A&P II (24 decks)

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