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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
Gas exhcange happens in the _______
alveoli
26
There are _____ generations of airway in the respiratory system
24
27
What generation is the trachea?
0
28
What generation is the bronchi?
1
29
What generation is the bronchioles?
4
30
What generation is the alveolar sacs?
23
31
How big is the diameter of an adult trachea? What happens to the diameter of the airway as we progress through generations?
2 cm The diameter gets smaller
32
There are ____ main stem bronchi. What are they?
2 Right & Left
33
What is the trachea and the bronchioles made of? What is the purpose of this?
Cartilage structural support to keep them open & patent
34
What is the conducting zone? What areas are included in this?
Area with no gas exchange just a conduit for old/fresh air flow Trachea Bronchi Bronchioles
35
What is the transitional zone? what area is included in this?
Area where a **very small** amount of gas exchange happen Respiratory bronchioles
36
What is the respiratory zones? What areas are included in this?
Areas where gas exchange happens Alveolar ducts alveolar sacs
37
What is the Alveoli made of?
soft tissue
38
What is the diameter of an alveolar sac?
0.04 cm
39
On drawings, how are alveoli represented?
Small little bumps
40
Define: Eupnea
Normal breathing
41
Define: Dyspnea
Respiratory distress
42
Define: apnea
Not breathing
43
Define: stridor
Funny sound breathing/wheezy ---asthma/ tumor related
44
Define: Bradypnea
Slow breathing
45
Define: Tachypnea
Rapid breathing
46
Define: orthopnea
Change breathing with change in body position
47
Define: hyperpnea
Fast/over breathing (similar to tachypnea)
48
Define: hyperventilation
Ventilation that is occurring well in access of metabolic demand
49
Define: hypoventilation
Insufficient ventilation for metabolic demands
50
Define: hyperinflation
Large lungs and chest --> large larger than they should be Ex) COPD
51
Define: cyanosis
DeoxyHb > 5gm/dL
52
Why do we turn blue when we are cyanotic?
DeoxyHb is blue --> increased DeoxyHb in body = more blue we turn
53
Define: Hypoxia
Not enough O2 at the level of a tissue **localized problem**
54
Define: Hypoxemia
Lower than normal O2 in the entire system in arterial blood **systemic/global deficit**
55
Define: hypercapnia/ hypercarbia
Excessive CO2 in arterial blood
56
Define: hypocapnia/ hypocarbia
Deficiency of CO2 in arterial blood
57
Define: Hyperoxia
O2 levels above normal **specific organ/tissue problem**
58
Define: Atelectasis
Collapse of portion or region of lung
59
1 mmHg =
1.36 cmH2O 13.6 mmH2O
60
Why do we use water instead of mercury for chest pressures?
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
Abbreviations: pressure
P
62
Abbreviations: aterial
a
63
What is total gas content?
It is how much gas we have in a sample. Ex) O2 content: how much oxygen we have in a sample of blood.
64
1 dL of normal art blood has ______ of O2 in it.
20 ml There is 20 mls of O2/dL of blood
65
Abbreviations: Alveolar
A
66
Abbreviations: Venous
v **lower case**
67
Abbreviations: ventilation
V **capital**
68
Abbreviations: expired
E
69
Abbreviations: inspired
I
70
Abbreviations: tidal volume
VT
71
What represents quantity per minute?
Small dot above the abbreviation
72
What are capacities?
volume amounts that are combined
73
What are volumes?
Different amounts of air in the lungs
74
When the compliance of the lungs is low it makes them _______ to ventilate
harder
75
What is elastance?
Inverse of compliance
76
Low compliance = ________ elastance
high
77
Which breath is easier to measure?
Expiration
78
Each dl of blood delivers _____ O2 to tissues each _______
5ml minute
79
What is total lung capacity? Abbreviation? Value?
TLC 6.0 L Max amount of air we can get in both lungs **3L in each lung**
80
What is Inspiratory capacity? Abbreviation? Value?
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
What is Functional Residual Capacity? Abbreviation? Value?
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
What is the physiological purpose of FRC?
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
What is Inspiratory reserve volume? Abbreviation? Value?
IRV 2.5 L Additional amount we can inspire if we wanted to about VT w max effort
84
What is tidal volume? Abbreviation? Value?
VT 0.5 L Normal breath for inhale/exhale
85
What is expiratory reserve volume? Abbreviation? Value?
ERV 1.5 L volume of air we could push out after expiration with effort if upright and healthy **removalable air**
86
What is residual volume? Abbreviation? Value?
RV 1.5 L Air that you cannot push out the lungs no matter what --> trying to push out will close the airway
87
What is Vital capacity? Abbreviation? Value?
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
How does laying on your back change your lung volumes/capacities?
extra air comes out lungs wt goes into stomach --> **pushes diaphragm up** --> **ERV gets squeezed out dt gravity** ERV decreases IRV increases
89
T/F: Your body doesnt absorb O2 in-between breaths
F Your body has 3 L of air in lungs between breaths --> able to absorb O2
90
What is a normal tidal volume?
500 cc
91
Abbreviation: pleural/intrapleural pressure
PIP
92
How is air flow rate measured?
Volume/time
93
With air flow rate, inspired air is ______ and expired air is ________
negative positive
94
What is transpulmonary pressure? Abbreviation?
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
What is the normal RR?
12 bpm
96
What is the pressure in the chest inbetween breaths?
-5cmH2O
97
If PTP is increased, what does this mean?
air is going into the lungs
98
How long are inspiration/expiration times? A breathing cycle? How many seconds are there between each breath?
2 seconds 5 seconds 1 second **Remember the entire cycle is 5 seconds**
99
What is the alveoli pressure in between breaths?
0
100
When is alveoli pressure the lowest? Highest?
-1 cmH2O: Lowest at 1 second into inspiration +1 cmH2O: Highest at 1 sec into expiration or 3 sec into respiratory cycle
101
What measurement correlates with alveolar pressure?
airflow
102
When is airflow the fastest?
(-) 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
What is the intrapleural pressure at the end of inspiration? When do you reach this point?
-7.5cmH2O When diaphragm contracts & inhale a tidal volume of 500 cc
104
What happens during inspiration?
Diaphragm contracts/lungs expand --> pressure in thorax becomes more negative --> alveolar pressure becomes negative --> air gets pulled in from environment
105
When does air come in the lung the quickest?
When alveolar pressure is more negative
106
What happens when air goes into the lungs?
Alveoli fills up --> breath ends --> alveoli pressure back at 0
107
What do we rely on to get air out the lungs?
Passive recoil
108
COPD is a problem getting air ____ the lungs and fibrosis is a problem getting air _____ the lungs
out in
109
What is each alveoli surrounded by?
about 1000 pulmonary capillaries for gas exchange
110
What is blood flow through the lungs mainly dependent on?
Gravity
111
How many West perfusion zones are there?
4
112
Describe zone 2. Formula.
Pa > PA > Pv **intermittent blood flow** --> depends on BP Increased BP = increased pulm pressure = increased perfusion &vice versa Less perfusion happens here
113
Describe zone 3. Formula.
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
Describe the physiology of zone 3.
Increase BP in compliant vessels dt gravity --> stretched out & wider vessels --> decreased resistance --> increased perfusion
115
_____ lung goes down
good
116
Describe zone 1. Formula.
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
What are variables that can cause a pt to have zone 1 in the lungs?
PEEP --> (Equation: causes pressure in the alveoli to be higher)
118
Where are the pressures in the lung the lowest in an upright pt? What will this cause to the area?
apical/superior part of lung --> causes decreased perfusion **Remember anatomical position can change this!!**
119
Describe zone 4.
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

AP2 (21 decks)

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