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AP2 > Lecture 2/20 - Pulmonary > Flashcards

Lecture 2/20 - Pulmonary Flashcards

Test 2

1
Q

The thorax is a continous _______ unit that includes: __________ (3)

A

Sealed

Lungs
Chest
Heart

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2
Q

Which lung is bigger? Why? Where can it extend to?

A

R lung is bigger

L lung has chunk carved out for heart

Can extend past rib 1 & clavicle

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3
Q

What happens if diaphragm contracts while R side is paralyzed?

A

R side will come up
L side will drop down

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4
Q

How many leaflets does the diaphragm have?

A

2

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5
Q

What are the 2 different types of pleura in the lungs called? Where are they located? What do they do?

A

Visceral pleura: Outside of lung

Parietal pleura: inside of thorax

lining of connective tissue with coating of mucous that helps the lungs slide around thorax/chest easy

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6
Q

What is the space between the visceral and parietal pleura called?

A

“potential space”

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7
Q

Pain from lungs being unable to slide around properly dt friction is normally related to _______ & ________

A

infection

inflammation

of parietal and visceral pleura

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8
Q

During inspiration, the diaphragm contracts causing the lungs to _______ into the ______. What effect does this have on the thoracic cavity?

A

Expand

Abd

Pulls thoracic cavity down

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9
Q

When you inspire, what happens to the presure in the lungs?

A

Diaphragm contracts –> lungs pulled down –> Pressure becomes more negative in lungs –> able to suck air in from the environment

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10
Q

Where is the diaphragm anchored at? What vertebrae are these associated with?

A

L & R crus

L: L1 - L2
R: L1 - L3

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11
Q

From the diaphragm view, what is the opening from the vena cava called?

A

Caval aperture

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12
Q

From the diaphragm view, where does the arterial blood flow to the abd?

A

aortic aperture

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13
Q

From the diaphragm view, what does the middle of the diaphragm sit on? Where is it?

A

Central tendon

Middle of the thoracic cavity

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14
Q

From the diaphragm view, what is the opening to the esophagus?

A

Esophageal aperture

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15
Q

What does the phernic nerve do? Where are they located? What vertebrae are they associated with?

A

Connect to the 2 sides of the diaphragm that they innerate

Along side of neck –> down past heart –> diaphragm (yellow)

C3-C5

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16
Q

What is in the same area as the phernic nerve? What considerations should we have with this?

A

Brachial and cervical plexuses

Regional block –> anesthesia leakout from area –> could knock out phrenic nerve –> affect diaphragm –> respiratory compromise

This could be a problem in someone who already has resp issues

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17
Q

T/F: You need both phrenic nerves to stay alive

A

F

You only need 1

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18
Q

T/F: There are many nerves that connect to the heart & mediastinum

A

T

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19
Q

What is the main muscle used for ventilation?

A

Diaphragm

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20
Q

_________ gives help w/ ventilation in addition to the diaphragm. How do they work?

A

Accessory Muscles

They are anchored into the base of the skull to the top of the neck & prevent the thorax from being pulled down when diaphragm contracts

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21
Q

Where are the Scalene muscles located?

A

Anterior: C3-C6 & rib 1
Middle: C3-C7 & rib 1
Posterior: C5-C7 & rib 2

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22
Q

What other muscles can help increase ventilation?

A

Accessory muscles (Scalene)
Abdominal muscles
Intercostal muscles

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23
Q

The top of the airway is the ______. What is here?

A

Larynx

The voice box is here

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24
Q

Air is drawn into the lung through the ________

A

trachea

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25
Q

Gas exhcange happens in the _______

A

alveoli

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26
Q

There are _____ generations of airway in the respiratory system

A

24

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27
Q

What generation is the trachea?

A

0

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28
Q

What generation is the bronchi?

A

1

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29
Q

What generation is the bronchioles?

A

4

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30
Q

What generation is the alveolar sacs?

A

23

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31
Q

How big is the diameter of an adult trachea? What happens to the diameter of the airway as we progress through generations?

A

2 cm

The diameter gets smaller

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32
Q

There are ____ main stem bronchi. What are they?

A

2

Right & Left

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33
Q

What is the trachea and the bronchioles made of? What is the purpose of this?

A

Cartilage

structural support to keep them open & patent

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34
Q

What is the conducting zone? What areas are included in this?

A

Area with no gas exchange just a conduit for old/fresh air flow

Trachea
Bronchi
Bronchioles

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35
Q

What is the transitional zone? what area is included in this?

A

Area where a very small amount of gas exchange happen

Respiratory bronchioles

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36
Q

What is the respiratory zones? What areas are included in this?

A

Areas where gas exchange happens

Alveolar ducts
alveolar sacs

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37
Q

What is the Alveoli made of?

A

soft tissue

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38
Q

What is the diameter of an alveolar sac?

A

0.04 cm

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39
Q

On drawings, how are alveoli represented?

A

Small little bumps

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40
Q

Define: Eupnea

A

Normal breathing

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41
Q

Define: Dyspnea

A

Respiratory distress

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42
Q

Define: apnea

A

Not breathing

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43
Q

Define: stridor

A

Funny sound breathing/wheezy
—asthma/ tumor related

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44
Q

Define: Bradypnea

A

Slow breathing

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45
Q

Define: Tachypnea

A

Rapid breathing

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46
Q

Define: orthopnea

A

Change breathing with change in body position

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47
Q

Define: hyperpnea

A

Fast/over breathing

(similar to tachypnea)

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48
Q

Define: hyperventilation

A

Ventilation that is occurring well in access of metabolic demand

49
Q

Define: hypoventilation

A

Insufficient ventilation for metabolic demands

50
Q

Define: hyperinflation

A

Large lungs and chest –> large larger than they should be

Ex) COPD

51
Q

Define: cyanosis

A

DeoxyHb > 5gm/dL

52
Q

Why do we turn blue when we are cyanotic?

A

DeoxyHb is blue –> increased DeoxyHb in body = more blue we turn

53
Q

Define: Hypoxia

A

Not enough O2 at the level of a tissue

localized problem

54
Q

Define: Hypoxemia

A

Lower than normal O2 in the entire system in arterial blood

systemic/global deficit

55
Q

Define: hypercapnia/ hypercarbia

A

Excessive CO2 in arterial blood

56
Q

Define: hypocapnia/ hypocarbia

A

Deficiency of CO2 in arterial blood

57
Q

Define: Hyperoxia

A

O2 levels above normal

specific organ/tissue problem

58
Q

Define: Atelectasis

A

Collapse of portion or region of lung

59
Q

1 mmHg =

A

1.36 cmH2O

13.6 mmH2O

60
Q

Why do we use water instead of mercury for chest pressures?

A

cmH2O gives us a better resolution for low pressures bc water is less dense than mercury

Able to see small differences better at low pressures.

61
Q

Abbreviations: pressure

62
Q

Abbreviations: aterial

63
Q

What is total gas content?

A

It is how much gas we have in a sample.

Ex) O2 content: how much oxygen we have in a sample of blood.

64
Q

1 dL of normal art blood has ______ of O2 in it.

A

20 ml

There is 20 mls of O2/dL of blood

65
Q

Abbreviations: Alveolar

66
Q

Abbreviations: Venous

A

v

lower case

67
Q

Abbreviations: ventilation

68
Q

Abbreviations: expired

69
Q

Abbreviations: inspired

70
Q

Abbreviations: tidal volume

71
Q

What represents quantity per minute?

A

Small dot above the abbreviation

72
Q

What are capacities?

A

volume amounts that are combined

73
Q

What are volumes?

A

Different amounts of air in the lungs

74
Q

When the compliance of the lungs is low it makes them _______ to ventilate

75
Q

What is elastance?

A

Inverse of compliance

76
Q

Low compliance = ________ elastance

77
Q

Which breath is easier to measure?

A

Expiration

78
Q

Each dl of blood delivers _____ O2 to tissues each _______

A

5ml

minute

79
Q

What is total lung capacity? Abbreviation? Value?

A

TLC

6.0 L

Max amount of air we can get in both lungs
3L in each lung

80
Q

What is Inspiratory capacity? Abbreviation? Value?

A

IC

3.0 L

Combo of amount of air we can take in (VT+ IRV) –> 0.5 L + 2.5 L

starts from FRC –> TLC

81
Q

What is Functional Residual Capacity? Abbreviation? Value?

A

FRC

3.0 L

Amount of air in the lungs after expiring a normal breath WHEN UPRIGHT & BREATHING NORMALLY (RV + ERV) –> 1.5 L + 1.5 L

82
Q

What is the physiological purpose of FRC?

A

Functional residual capacity = air left in lung after normal expiration

Helps stabilize blood gasses
-Helps hold airways open since the alveoli dont have cartilage –> prevents them from collapsing

83
Q

What is Inspiratory reserve volume? Abbreviation? Value?

A

IRV

2.5 L

Additional amount we can inspire if we wanted to about VT w max effort

84
Q

What is tidal volume? Abbreviation? Value?

A

VT

0.5 L

Normal breath for inhale/exhale

85
Q

What is expiratory reserve volume? Abbreviation? Value?

A

ERV

1.5 L

volume of air we could push out after expiration with effort if upright and healthy
removalable air

86
Q

What is residual volume? Abbreviation? Value?

A

RV

1.5 L

Air that you cannot push out the lungs no matter what –> trying to push out will close the airway

87
Q

What is Vital capacity? Abbreviation? Value?

A

VC

4.5 L

Total amount of air we could expire if we inspire to total lung capacity.

ERV + VT + IRV
1.5 + 0.5 + 2.5

88
Q

How does laying on your back change your lung volumes/capacities?

A

extra air comes out lungs

wt goes into stomach –> pushes diaphragm up –> ERV gets squeezed out dt gravity

ERV decreases
IRV increases

89
Q

T/F: Your body doesnt absorb O2 in-between breaths

A

F

Your body has 3 L of air in lungs between breaths –> able to absorb O2

90
Q

What is a normal tidal volume?

91
Q

Abbreviation: pleural/intrapleural pressure

92
Q

How is air flow rate measured?

A

Volume/time

93
Q

With air flow rate, inspired air is ______ and expired air is ________

A

negative

positive

94
Q

What is transpulmonary pressure? Abbreviation?

A

PTP

Pressure used to put air into the lungs
-differences of pressures on 2 sides of the wall from air on lung & tissue surrounding lung

95
Q

What is the normal RR?

96
Q

What is the pressure in the chest inbetween breaths?

97
Q

If PTP is increased, what does this mean?

A

air is going into the lungs

98
Q

How long are inspiration/expiration times? A breathing cycle? How many seconds are there between each breath?

A

2 seconds

5 seconds

1 second

Remember the entire cycle is 5 seconds

99
Q

What is the alveoli pressure in between breaths?

100
Q

When is alveoli pressure the lowest? Highest?

A

-1 cmH2O: Lowest at 1 second into inspiration

+1 cmH2O: Highest at 1 sec into expiration
or 3 sec into respiratory cycle

101
Q

What measurement correlates with alveolar pressure?

102
Q

When is airflow the fastest?

A

(-) 0.5 L/sec: at 1 sec during inspiration

0.5 L/sec: at 1 sec during expiration
or 3 sec into respiratory cycle

Remember the (-) just means the air flow is coming inward!! Not actually a negative value

103
Q

What is the intrapleural pressure at the end of inspiration? When do you reach this point?

A

-7.5cmH2O

When diaphragm contracts & inhale a tidal volume of 500 cc

104
Q

What happens during inspiration?

A

Diaphragm contracts/lungs expand –> pressure in thorax becomes more negative –> alveolar pressure becomes negative –> air gets pulled in from environment

105
Q

When does air come in the lung the quickest?

A

When alveolar pressure is more negative

106
Q

What happens when air goes into the lungs?

A

Alveoli fills up –> breath ends –> alveoli pressure back at 0

107
Q

What do we rely on to get air out the lungs?

A

Passive recoil

108
Q

COPD is a problem getting air ____ the lungs and fibrosis is a problem getting air _____ the lungs

109
Q

What is each alveoli surrounded by?

A

about 1000 pulmonary capillaries for gas exchange

110
Q

What is blood flow through the lungs mainly dependent on?

111
Q

How many West perfusion zones are there?

112
Q

Describe zone 2. Formula.

A

Pa > PA > Pv

intermittent blood flow –> depends on BP

Increased BP = increased pulm pressure = increased perfusion
&vice versa

Less perfusion happens here

113
Q

Describe zone 3. Formula.

A

Pa > Pv > PA

Continuous (Always on) blood flow –> dependent on gravity

This is the bottom of the lung in an upright pt
part of lung thats closest to earth

114
Q

Describe the physiology of zone 3.

A

Increase BP in compliant vessels dt gravity –> stretched out & wider vessels –> decreased resistance –> increased perfusion

115
Q

_____ lung goes down

116
Q

Describe zone 1. Formula.

A

PA > Pa > Pv

Always off blood flow –> not present in healthy pts

Top of lung
-present in unhealthy or vented pts
happens when pressure surrounding capillaries increases

117
Q

What are variables that can cause a pt to have zone 1 in the lungs?

A

PEEP –> (Equation: causes pressure in the alveoli to be higher)

118
Q

Where are the pressures in the lung the lowest in an upright pt? What will this cause to the area?

A

apical/superior part of lung –> causes decreased perfusion

Remember anatomical position can change this!!

119
Q

Describe zone 4.

A

Located at very base of lungs where there is a slight decrease in perfusion

this is dt blood vessels getting compressed from being suspended in chest

IN UPRIGHT PATIENT –> pt not in upright position will not have compression on central tendon

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