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AP2 > Lecture 2/25 - Pulmonary > Flashcards

Lecture 2/25 - Pulmonary Flashcards

Test 2

1
Q

What is zone 3 of the lung known as? Why?

A

The “dependent” area of the lung

Part of the lung that’s closest to the heart –> has the highest flow

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2
Q

Zone 2 has _______ flow and zone 3 has ______ flow

A

pulsatile

continuous

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3
Q

Increased wt of blood from gravity = _________ of vessel = ________ vascular resistance = _______ blood flow

A

distention

decreased

increased

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4
Q

Why does zone 4 exist?

A

dt the compression of the blood vessels in base of the lung

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5
Q

PER =

A

PTP

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6
Q

PA =

A

PIP + PER

or

PIP + PTP

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7
Q

What is another name for elastic recoil pressure?

A

Transpulmonary pressure

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8
Q

Increased lung stretch = _______ recoil

A

increased

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9
Q

Increased PTP = ________ lung volume

A

increased

(transpulmonary pressure)

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10
Q

What is PTP?

A

Transpulmonary pressure

Pressure thats available to fill the lung up with air

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11
Q

What are the balanced forces at the start of the respiratory cycle?

A

PA= 0 cmH2O
PIP= -5 cmH2O
PER= 5 cmH2O

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12
Q

What is the tendency of the alveoli? Why?

A

They want to recoil into a smaller container

They are made of elastic soft tissue.

elastic = recoil

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13
Q

What keeps air in the alveoli? Explain this in correlation to FRC

A

Negative pleural pressure

-5cmH2O pleural pressure keeps our 3L FRC in the lungs in between breaths

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14
Q

T/F: During inspiration the forces are balanced. What does this mean?

A

F

The forces are unbalanced.
PA= 0
PIP= -6
PER = 5

The pleural pressure has now dropped from -5 cmH2O to -6.

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15
Q

During inspiration, how are we able to suck air in?

A

Pleural pressure -6 –> forces unbalanced –> alveolar pressure -1

This creates a (delta)P with the outside environment and inside the alveoli –> able to suck air into lungs

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16
Q

How does the alveoli pressure get back to 0 after inspiration?

A

Inward recoil pressure has to be higher than it was before

PA= -1
PIP= -6
PER = 5

PER would need to increase to 6 cmH2O as a result of air coming in and alveoli being stretched out –> PA= 0

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17
Q

Increased volume = _______ recoil

A

increased

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18
Q

When you exhale, the diaphragm ________ and the lungs _________

A

relaxes

contract

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19
Q

During the relaxation of the diaphragm, how do we fix the out of balance forces?

A

We have excess recoil

PA= 0
PIP= -5
PER = 6

Alveoli pressure will become +1 –> we have a (delta)P –> able to push air out of lungs –> alveoli gets smaller & recoil pressure decreases

This would mark the end of expiration

Forces should be back balanced.

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20
Q

What are the 2 most important passive factors to PVR? Which has the biggest influence?

A

1. Gravity/body position <– biggest influnence

  1. Increase/decrease in lung volume
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21
Q

Lung volume refers to ______ volume

A

air

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22
Q

What medications can you put down an ETT that increase PVR? What type of influence is this?

A

NE/Epi

Active influence

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23
Q

How do active influences in the pulm vessels work?

A

similiar to systemic system –> constricting/dilating the pulm vessels

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24
Q

According to the PVR graph, At normal FRC, PVR is at its _______ point. What is the importance of this point?

A

lowest

Easiest for heart to pump blood & body spends most of its time near FRC.

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25
Q

What happens to PVR if you increase or decrease lung volume from FRC?

A

PRV increases

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26
Q

What is the lowest possible lung volume we can be at?

A

RV = 1.5 L

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27
Q

What is the highest possible volume we can be at?

A

TLC = 6L

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28
Q

Why is the PVR graph skewed to the left?

A

It doesn’t start at 0

And because IRV (2.5L) is larger than ERV (1.5L)

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29
Q

What is the difference between an extraalveolar and an alveolar blood vessel?

A

Extraalveolar: large pulmonary blood vessel

alveolar blood vessel: smaller pulmonary capillary

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30
Q

At low lung volumes, describe extraalveolar PVR

A

It is very high dt higher pleural pressue

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31
Q

As lung volume increases, alveolar blood vessel PVR ______

A

increases

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32
Q

On the PVR graph, what is the blue line represent?

A

Total PRV: consist of equal sum of individual vascular resistances of both extraalveolar and alveolar

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33
Q

What are some pathology that will alter the FRC and change the PVR graph?

A

COPD: increases lung volume

PEEP: increases pressure on vessels

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34
Q

What is another name for the alveolar blood vessels?

A

Pulmonary capillaries

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35
Q

T/F: gas exchange happens in the extraalveolar blood vessels

A

F

Only in the alveolar blood vessels/pulmonary capillaries

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36
Q

What is considered the functional unit of the lungs?

A

alveoli

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37
Q

Decreasing pleural pressure = _________ in alveolar PVR

38
Q

How does more air in the alveoli affect the alveolar blood vessels? Less air?

A

More air: longer capillaries w/ smaller diameter –> increase in resistance

Less air: shorter cap w/ larger diameter –> decrease in resistance

39
Q

What 2 things affect alveolar blood vessel PVR?

A

1) Air volume in the alveoli
2) pleural pressure

40
Q

What are the extraalveolar blood vessels PVR affected by?

A

Pleural pressure

41
Q

When pleural pressure decreases during inspiration, PVR ________ in the extraalveolar blood vessels. Why?

A

decreases

The lower pleural pressure in the chest pulls the vessesl and increases the diameter

42
Q

Extraalveoli and alveolar blood vessels PVR has a _________ relationship

43
Q

What is significant about extraalveolar and alveolar blood vessel PVR value at FRC?

A

They are low at this point causing that to be the lowest point

44
Q

Describe the location of capillaries in relation to an alveoli

A

embedded in walls right next to where air –> good for gas exchange

45
Q

_____ (2) causes problems with gas exchange

A

water
excess tissue

46
Q

How does increasing CO affect PVR?

A

Decreases it

Distention: Increasing CO puts more blood thru vessels

Recruitment: Also utilizes unused pathways –> increases parallel pathways

These things decrease PVR

47
Q

Do you use all your alveoli with each breath? Why?

A

No, there are large spotty areas of unused alveolis and IT IS NORMAL

We dont want to use all of our alveoli all the time –> if breathing in toxins –> all alveoli exposed to that toxin

Not using them all, all the time prevents things like this.

48
Q

Increase/decrease in CO that affects PVR is considered a ________

A

Passive force

49
Q

Increased Right heart CO = _________ PVR

50
Q

What can cause decreased right heart CO?

A

MI
R heart failure

51
Q

How can decreased R heart CO become a vicious cycle?

A

Decreased R heart CO increases PVR –> this will further decrease R heart CO –> vicious cycle

52
Q

What passive influences decrease PVR? How? (6)

A
  1. Gravity
  2. Body Position
    -hydrostatic effects of recruitment/distention
    Decreases in gravity dependent regions
  1. Increased LAP
  2. Increased pulm blood volume
  3. Increased CO
  4. Increased PAP
    -Recruitment /distention
53
Q

What passive influences increase PVR? How? (5)

A
  1. Increase lung volume from FRC: lengthening/compression of alveolar vessels
  2. Decrease lung volume from FRC: compression/less traction of extraalveolar vessels
  3. Increased interstial pressure: compresses vessels close to alveoli
  4. Increased blood viscosity: blood harder to get thru circuit
  5. Positive-pressure ventilation (increased alveolar pressure/positive intrapleural pressure): compression/derecruitment of alveolar/extraalveolar vessels
54
Q

What are ACTIVE influences that increase PVR? (12)

A
  1. SNS inneration
  2. NE/Epi
  3. Alpha-adenergic agonist
  4. PGF2A
  5. PGE2
  6. Throboxane
  7. Endothelium
  8. Angiotensin
  9. Histamine
  10. Alveolar hypoxia
  11. Alveolar hypercapnia
  12. Low pH
55
Q

What are ACTIVE influences that decrease PVR?

A
  1. PNS stimulation/decrease in SNS stimulation
  2. ACH
  3. Beta-adrenergic agonists
  4. PGE1
  5. Prostacyclin (PGI2)
  6. Nitric Oxide
  7. Bradykinin
56
Q

Histamine is a veno_______ in the systemic circulation and a veno_______ in the pulmonary circuit

A

dilator

constrictor

57
Q

What 2 things do you need to get gasses into the body?

A

Gas
Pressure

58
Q

What is the complete make up of our DRY atmospheric gasses?

A

N2 (Nitrogen): 79% – 600.3 mmHg

O2 (Oxygen): 21% – 159.0 mmHg

CO2/trace gasses (Carbon dioxide/methane): 0.04% – 0.3 mmHg

59
Q

What is our total atmospheric pressure at sea level?

60
Q

T/F: Concentration of gasses changes at different altitudes

A

F

The concentrations will always stay the same, but what changes is the atomspheric pressures –> which changes the partial pressures

61
Q

Partial pressure =

A

Total pressure x [gas concentration percentage in decimal]

62
Q

760 mmHg =

A

760 torr

1 atm

63
Q

The lower you are = ________ atmospheric pressure

64
Q

The higher you are = ____________ atomospheric pressure

65
Q

What changes with gas mixtures at extremely high altitudes? What is an example of this?

A

Total atmospheric pressures will decrease –> oxygen partial pressure will decrease!!!

Ex) If you go on a plane and the door flies open –> high altitude –> wont have enough O2 bc decrease O2 partial pressure –> reason why masks fall down

66
Q

What is the definition of inspired humified gas? What consideration to we have with inspired humidified gas?

A

Inspired gas at body temperature = 37.0 C & 100% water vapor saturated

Considerations: Can only have 760 mmHg so OTHER GASSES ARE DISPLACED dt warmth & humidity

67
Q

What gas is displaced the most with inspired humidifed gas? Why?

A

Nitrogen

Because concentration is the highest (79%)

68
Q

How do abbreviate gas concentrations?

A

[ ] <—— with these brackets

or

F

69
Q

About how much does O2 partial pressure decrease from displacement with inspired humidifed gas?

70
Q

What is the partial pressure of water in inspired humified gas?

71
Q

How do you abbreviate inspired air?

A

subcript I

Ex) PIO2> = Inspired O2 pressure

72
Q

Inspired gas is _________ by water vapors

73
Q

T/F: Volatile anesthetics are diluted by water vapors in inspired humidified gas

74
Q

What is the the formula for inspired gas concentration?

A

(partial pressure) = (gas concentration)(Atomspheric pressure - partial pressure of water)

Ex) 149 = (.29)(760 - 47)

75
Q

T/F: Water vapor can be displaced during inspiration

A

F

Water is BIG DADDY, it CANNOT be displace. It will always be 47.0 mmHg

76
Q

Partial Pressure of water will ALWAYS be ______ and it will ______ change

A

47.0 mmHg

NEVER CHANGE

IT WILL NEVER CHANGE

77
Q

What is the PO2 and PCO2 that is inhaled?

A

PIO2 = 149 mmHg
PICO2 = 0.3 mmHg (or 0)

78
Q

________ of air is lost in the _________ during inspiration

A

150 cc

dead space

79
Q

How much air makes it to the alveoli?

80
Q

What is the Pressure in the pulmonary arteries for O2 and CO2?

A

PaO2 = 40 mmHg
PaCO2 = 45 mmHg

81
Q

How would you describe pulmonary arterial blood?

A

Deoxygenated systemic venous blood going into the lung for gas exchange (to be oxygenated)

82
Q

What is the average alveolar gas pressure? What is significant about this number/area?

A

PAO2 = 100 mmHg
PACO2 = 40 mmHg

This is where O2 is put into the circulation and CO2 is taken out of circulation

83
Q

How much CO2 is offloaded from the pulomary arteries into the alveoli?

84
Q

How much O2 is put into the pulomary veins from the alveoli in addition to what was already in the pulmonary arteries??

85
Q

What are gas pressures in the pulmonary vein after gas exchange with the alveoli?

A

PvO2 = 100 mmHg
PvCO2 = 40 mmHg

86
Q

The average alveolar pressures has the same values as the ___________

A

pulmonary vein pressures

87
Q

Pulmonary vein blood is considered _________

A

oxygenated

88
Q

Inspired air will ________ CO2 which will ______ the concentration in the lungs

A

dilute

decrease

89
Q

Inspired air will ______ the O2 concentration in the lungs

90
Q

Explain how equilivant amounts of O2 and CO2 are exchanged with inspiration and expiration.

A

Although the pressure of CO2 in the pulm vein decreased by 5 mmHg and O2 increased by 60 mmHg equal amounts are exchanged.

✅ CO₂ has a lower pressure gradient but higher solubility, so it diffuses efficiently.
✅ O₂ has a higher pressure gradient but lower solubility, so it needs hemoglobin for transport.
✅ Despite different pressure changes, equal amounts of gas are exchanged due to differences in solubility and transport.

91
Q

Alveolar pressures are the pressures ________ inspiration equilibrium

A

after

(after gas exchange)

92
Q

T/F: O2 absorption and unloading of CO2 is intermittent

A

F

It is a continuous thing

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