Lecture 2: Mechanics Of Respiration Flashcards

1
Q

What are the 4 goals of the respiratory system?

A
  1. Distribute air and blood flow for gas exchange
  2. Provide oxygen to cells in body tissues
  3. Remove carbon dioxide from body
  4. Maintain constant homeostasis for metabolic needs
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2
Q

What are the four functional events of respiration?

A
  1. Mechanics of pulmonary ventilation
  2. Diffusion of O2 and CO2 between alveoli and blood
  3. Transport of O2 and CO2 to and from tissues
  4. Regulation of ventilation and respiration
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3
Q

What is EXTERNAL respiration?

A
  • Mechanics of breathing
  • Movement of gases into and out of body
  • Gas transfer from lungs to tissues of body
  • Maintain body cellular homeostasis
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4
Q

What is INTERNAL respiration?

A
  • Intracellular oxygen metabolism
  • Cellular transformation
  • Krebs cycle—aerobic ATP generation
  • Mitochondria and O2 utilization
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5
Q

What is the main purpose of ventilation?

A

To maintain an optimal composition of alveolar gas

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6
Q

Alveolar gas acts as a ___ ___ ___ between the ___ and ___.

A
  • stabilizing buffer compartment

- between the environment and pulmonary capillary blood

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7
Q

How does alveolar gas act as a stabilizing buffer compartment? (3 things)

A
  • Oxygen is constantly removed from alveolar gas by blood
  • Carbon dioxide continuously added to alveoli from blood
  • O2 replenished and CO2 removed by process of ventilation, by simple diffusion
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8
Q

What provides the stable alveolar environment?

A

The two ventilation phases—inspiration and expiration

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9
Q

Breathing is the act of ___

A

Creating inflow and outflow of air between the atmosphere and the lung alveoli

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10
Q

How much does the lung weigh?

A
  • 1.5% of body weight

- 1 kg in 70 kg adult

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11
Q

Alveolar tissue is ___ of lung weight

A

60%

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12
Q

Alveoli have ___

A

Very large surface area—40x the external body surface area

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13
Q

___ diffusion pathway for gases

A

Short

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14
Q

What does the short diffusion pathway for gases permit?

A

Permits rapid and efficient gas exchange into blood—only 1.5 micrometers between the air and alveolar capillary RBC (very thin layer)

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15
Q

What is the blood volume in the lung?

A

500 mL (10% of total blood volume)

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16
Q

Respiratory muscles generate ___ to inflate and deflate the lungs

A

Force

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17
Q

What are two things that impede ventilation?

A

Tissue elastance and resistance

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18
Q

What are two other factors that alter lung volumes?

A
  • Distribution of air movement within the lung, resistance within the airway
  • Overcoming surface tension within alveoli
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19
Q

Air flow requires ___

A

A pressure gradient

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20
Q

Air flows from ___ to ___ pressures

A

High to low

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21
Q

During inspiration, alveolar pressure is ___

A

Sub-atmospheric, allowing air flow into the lungs

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22
Q

During expiration, alveolar pressure is ___

A

Higher than atmospheric pressure, allowing airflow out of the lungs

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23
Q

What generates changes in alveolar pressure?

A

Changes in pleural pressure

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24
Q

Inspiration is the ___ phase of the breathing cycle

A

ACTIVE phase

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25
Q

What nerves transmit motor stimulation to the diaphragm?

A

Phrenic nerve—C3, 4, 5

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26
Q

What nerves send signals to the external intercostal muscles?

A

Intercostal nerves T1-T11

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27
Q

Describe what happens during inhalation (4 main things)

A
  • Thoracic cavity expands to lower pressure (to sub-atmospheric) in pleural space surrounding the lungs
  • Pressure in alveolar ducts/alveoli decreases
  • Fresh air flows through conducting airways into terminal air spaces until pressures are equalized
  • Lungs expand passively as pleural pressure falls
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28
Q

The act of inhaling is ___

A

Negative-pressure ventilation

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29
Q

What is the most important muscle of inspiration?

A

Diaphragm

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30
Q

The diaphragm is responsible for ___ of inspiratory effort

A

75%

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31
Q

What is the diaphragm?

A

Thin, dome-shaped muscle attached to the lower ribs, xiphoid process, lumbar vertebra

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32
Q

What is the diaphragm innervated by?

A

Phrenic nerve—C3, 4, 5

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33
Q

During contraction of diaphragm—abdominal contents are forced ___

A

Downward and forward, causing an increase in vertical dimension of chest cavity

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34
Q

During contraction of diaphragm—rib margins are ___

A

Lifted and moved outward, causing increase in the transverse diameter of the thorax

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35
Q

How much does the diaphragm move down during normal inspiration?

A

1 cm

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36
Q

How much does the diaphragm move down during forced inspiration?

A

10 cm

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37
Q

What happens to the diaphragm when paralyzed?

A
  • Paradoxical movement
  • Upward movement with inspiratory drop of intrathoracic pressure
  • Occurs when the diaphragm muscle is denervated (paralyzed)
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38
Q

What is transdiaphragmatic pressure?

A

When the effect of abdominal pressure on the chest wall mechanics is transmitted across the diaphragm

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39
Q

In supine position, abdominal pressure equals ___

A

Atmospheric pressure (when respiratory muscles are relaxed)

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40
Q

What happens to the diaphragm when abdominal pressure is increased?

A

The diaphragm is pushed cephalad (towards the head) into the thoracic cavity, decreasing functional residual capacity (FRC)

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41
Q

FRC is reduced by…

A

Increased intra-abdominal pressure situations
Examples: pregnancy, obesity, bowel obstruction, laparoscopic surgery, ascites, abdominal mass, hepatomegaly, trendelenburg position, valsalva maneuver

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42
Q

What are 3 positions that can decrease abdominal pressure and allow easier lung ventilation?

A
  • Upright
  • Reverse trendelenburg
  • Prone position
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43
Q

What do the external intercostal muscles connect to?

A

Adjacent ribs

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44
Q

EIM are responsible for ___ of inspiratory effort

A

25%—diaphragm is responsible for 75%

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45
Q

Where do the nerves that innervate the intercostal muscles (intercostal nerves) originate?

A

Motor neurons to the EIM originate in the respiratory centers of the brainstem and travel down the spinal cord

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46
Q

Where do the intercostal nerves originate?

A

T1-T11

-The nerves pass under each rib along with the intercostal veins and arteries

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47
Q

Contraction of the EIM pulls the ribs ___

A

Upward and forward—ribs move outward in “bucket-handle” fashion

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48
Q

What happens to the diameters of the thorax when the EIMs contract?

A

Thorax diameters increase in both lateral and anteroposterior directions

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49
Q

What nerves innervate the EIMs?

A

Intercostal nerves

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50
Q

What happens with paralysis of the EIMs?

A

Inspiration is not seriously altered because the diaphragm is so effective
-Sensation of inhalation is decreased (i.e.: may see this in pregnant women under spinal anesthesia)

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51
Q

What do the accessory muscles of inspiration do?

A

They assist with forced inspiration during periods of stress or exercise

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52
Q

Scalene muscle

A
  • Attaches cervical spine to apical rib

- Elevates the first two ribs during forced inspiration

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53
Q

Sternocleidomastoid muscle

A
  • Attaches base of the skull (mastoid process) to top of sternum and clavicle medically
  • Raises the sternum during forced inspiration
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54
Q

What are two accessory muscles of inspiration?

A
  • Scalene muscle

- Sternocleidomastoid muscle

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55
Q

Expiration is the ___ phase of the breathing cycle

A

PASSIVE phase

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56
Q

During expiration—chest muscles and diaphragm ___

A

Relax

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57
Q

During expiration—pleural and alveolar pressures…

A

Rise

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58
Q

During expiration, gas flows ___

A

Passively out of the lung

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59
Q

Expiration is active during ___ and ___

A

Hyperventilation and exercise

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60
Q

What does active expiration require?

A

Abdominal and internal intercostal muscle contraction

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61
Q

What are 3 different muscles of active expiration?

A
  • Rectus abdominis
  • Abdominal oblique muscles
  • Internal intercostal muscles
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62
Q

Rectus abdominis/abdominal oblique muscles (function)

A
  • Contraction raises intra-abdominal pressure to move diaphragm upward
  • Intra-thoracic pressure raises and forces air out from lung
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63
Q

How do the internal intercostal muscles assist with active expiration?

A
  • Pull the ribs downward and inward
  • Decrease thoracic volume
  • Stiffen intercostal spaces to prevent outward bulging during straining
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64
Q

The muscles of active expiration also contract forcefully during ___, ___, and ___

A
  • coughing
  • vomiting
  • defecation
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65
Q

What is transpulmonary pressure?

A

-The pressure difference between the alveolar pressure and pleural pressure on the outside of the lungs

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66
Q

What happens to the alveoli when the pleural pressure attempts to pull outward?

A

Alveoli tend to collapse together

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67
Q

What is recoil pressure?

A

The elastic forces which tend to collapse the lung during respiration

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68
Q

What are two parts of the pleural membrane?

A
  • Visceral pleura

- Parietal pleura

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69
Q

What is visceral pleura?

A

A thin serosal membrane that envelopes the lobes of the lungs (surrounds the lungs)

70
Q

What is parietal pleura?

A

Lines the inner surface of the chest wall, lateral mediastinum, and most of the diaphragm

71
Q

The pleura space is enclosed by a ___

A

Continuous membrane

72
Q

The two pleural membranes (visceral and parietal)…

A
  • slide against each other

- are difficult to separate apart

73
Q

What are the two pleural membranes separated by?

A

Separated by a thin layer of serous fluid

-A large amount would be a pleural effusion, as seen in CHF, CA, infection

74
Q

What is the pleura sac?

A

-Contains both pleural membranes and a small amount of fluid inbetween them (serous fluid)

75
Q

What does pleural fluid do?

A
  • Functions as a lubricant between the membranes, prevents frictional irritation
  • Causes the visceral and parietal pleura to adhere together, maintains surface tension
  • Lymphatic drainage maintains constant suction on pleura (-5cm H2O)
76
Q

What is pleural pressure?

A

-The pressure of fluid in the space between the lung pleura (visceral) and chest wall pleura (parietal)

77
Q

Pleural pressure is always ___

A

Negative

78
Q

Normally at rest, suction creates a ___ pressure

A

NEGATIVE pressure at the beginning of inspiration (-5 cm H2O)

79
Q

What holds the lungs open at rest?

A

Negative pressure (-5 cm H2O)

80
Q

Pressure becomes more ___ during inspiration

A

More negative—moving to -7.5 cm H2O, allowing for negative pressure respiration

81
Q

What happens if pleural pressure becomes positive?

A

The lung will collapse—i.e.: pneumothorax, hemothorax, chylothorax

82
Q

TLC =

A

IRV + TV + ERV + RV

Total lung capacity = inspiratory reserve volume + tidal volume + expiratory reserve volume + residual volume

83
Q

VC =

A

IRV + TV + ERV

Vital capacity = inspiratory reserve volume + tidal volume + expiratory reserve volume

84
Q

FRC =

A

ERV + RV

Functional residual capacity = expiratory reserve volume + reserve volume

85
Q

IC =

A

TV + IRV

Inspiratory capacity = tidal volume + inspiratory reserve volume

86
Q

How many pulmonary volumes and capacities are there, and what are they based on?

A
  • 4 volumes, 4 capacities
  • Effort dependent
  • Values vary based on height, age, sex, and physical training
87
Q

IRV =

A

2.5 L

88
Q

TV =

A

0.5 L

89
Q

ERV =

A

1.5 L

90
Q

RV =

A

1 L

91
Q

IC =

A

3 L

IC = TV + IRV

92
Q

VC =

A

4.5 L

VC = IRV + TV + ERV

93
Q

FRC =

A

2.5 L

FRC = ERV + RV

94
Q

TLC =

A

5.5 L

TLC = IRV + TV + ERV + RV

95
Q

What does spirometry NOT measure?

A

Residual volume (RV)

96
Q

What can’t be measured using spirometry alone?

A

Functional residual capacity (FRC) and total lung capacity (TLC)

97
Q

What are 3 ways we can determine FRC and TLC?

A
  • helium dilution
  • nitrogen washout
  • body plethysmography
98
Q

What does compliance measure?

A

Compliance is a measure of the distensibility of the lungs

99
Q

Compliance =

A

Change in lung volume/change in lung pressure

100
Q

The extent of lung expansion is dependent on an increase in ___

A

Transpulmonary pressure

101
Q

What is normal static compliance?

A

70-100 mL of air/cm of H2O transpulmonary pressure

102
Q

What can reduce lung compliance?

A
  • Higher or lower lung volumes
  • Higher expansion pressures
  • Venous congestion
  • Alveolar edema
  • Atelectasis
  • Fibrosis
103
Q

What increases lung compliance?

A

-Age and emphysema secondary to alterations of elastic fibers

104
Q

What are the two fibers in elastic lung tissue?

A
  • Elastin

- Collagen

105
Q

What is the natural state of the elastin and collagen fibers?

A

Contracted coils

106
Q

How does the elastic lung tissue assist to deflate the lungs?

A
  • After the elastic fibers (elastin and collagen) are stretched and elongated, they return to a coiled state, thus generating an elastic force
  • The recoil force (the fibers returning to a coiled state) is what deflates the lungs
107
Q

What comprises 2/3 of the elastic force in the lung?

A

-The surface air-fluid interface (air entering the lungs + water/surfactant in the lung)

108
Q

What holds the alveoli open?

A

-Complex synergy between air and fluid

109
Q

What does surfactant do?

A

-Surfactant in the alveoli reduces the surface tension of water and keeps the alveoli from collapsing

110
Q

How does water tension contribute to the elastic force of the lung?

A
  • Water has a strong attraction to itself, causing high tension—the tension creates an elastic force
  • This elastic force caused by water tension attempts to force air out of the alveoli
111
Q

What is surfactant/what does it do?

A
  • Fatty-acid product of type II pneumocyte (DPPC)

- Surfactant lowers the surface tension of alveolar fluid

112
Q

What are the ends of the DPPC molecules?

A

-Hydrophobic and hydrophilic opposing ends

113
Q

How does DPPC reduce alveolar surface tension?

A

-DPPC opposes water’s self-attractant elastic force, thus reducing alveolar surface tension

114
Q

Effect of water on alveoli

A

Water attracts itself, causing high surface tension in the alveoli; this forces air out of the alveoli

115
Q

Effect of DPPC on alveoli

A

DPPC (surfactant) decreases the surface tension of water by breaking up water’s self-attracting forces; this prevents alveolar collapse

116
Q

What are 3 main functions of surfactant?

A
  • Lowers surface tension of alveoli and lung (increases compliance, reduces work of breathing)
  • Promotes stability of alveoli (prevents alveolar collapse)
  • Prevents transudation of fluid into alveoli (prevents surface tension forces from drawing fluid into alveoli from capillary)
117
Q

Total ventilation is AKA

A

Minute ventilation

118
Q

Minute ventilation is…

A

The total volume of air conducted into the lungs per minute

119
Q

Minute ventilation =

A

Tidal volume x frequency (number of breaths in one minute)

120
Q

What is alveolar ventilation?

A

The volume of fresh air entering the alveoli each minute (70% of total minute ventilation)

121
Q

Alveolar ventilation is always ___ total (minute) ventilation

A

Less than

122
Q

When is an alveolar O2 concentration steady state achieved?

A

When supply matches demand

123
Q

What is dead space?

A

Dead space = ventilated, but not perfused

124
Q

Dead space is the portion of tidal volume fresh air that…

A

Does not go directly to the terminal respiratory units; stays in the conducting airways, no gas exchange occurs (~30% of each breath, 150 ccs of tidal volume or 2 ccs/kg)

125
Q

The conducting airways do not participate in…

A

Gas exchange

126
Q

Dead space is approximately how much of ideal body weight?

A

2 ccs/kg of ideal body weight

127
Q

Anatomic dead space is different from ___

A

Physiological dead space (wasted ventilation)

128
Q

What is physiologic dead space?

A
  • AKA wasted ventilation

- Describes a deviation from ideal ventilation relative to blood flow

129
Q

Wasted ventilation (physiologic dead space, VPD) includes…

A

Anatomical dead space + any portion of alveolar ventilation that is not involved in gas exchange (alveolar dead space)

130
Q

Alveolar dead space is…

A

Any portion of alveolar ventilation that is not involved in gas exchange (exchange of O2/CO2 with pulmonary blood flow)

131
Q

Where do we see a V/Q mismatch?

A

Ventilation/blood flow mismatch is seen where blood flow is blocked (i.e.: d/t clot or emboli)

132
Q

VT = VA + VD

A

Tidal volume = alveolar volume + anatomical dead space

133
Q

VPD = VD + VAD

A

Wasted ventilation (or physiologic dead space) = anatomical dead space + alveolar dead space

134
Q

VT = VA + VD + VAD

A

Tidal volume = alveolar volume + anatomical dead space + alveolar dead space

135
Q

Is all the gas compressed out of the lungs during exhalation?

A
  • No—small airways in region of respiratory bronchioles collapse
  • Gas is trapped in distal alveoli
136
Q

Dependent (down) regions of the lung are only…

A

Intermittently ventilated, leading to defective gas exchange (i.e.: patients who are positioned laterally for procedures)

137
Q

What is closing volume (CV)?

A

Volume of the lung at which the small airways close

138
Q

What happens if CV > FRC?

A

Then the small airways collapse during normal TVs, leading to atelectasis and hypoxemia

139
Q

Airway closure occurs at ___ in normal young subjects in the lowermost lung regions

A

Very low lung volumes

140
Q

Airway closure occurs in normal elderly lungs at ___ volumes and can be present at FRC

A

Higher

141
Q

Airway closure frequently develops in ___

A

Patients with chronic lung disease

142
Q

Air flow at low flow rates is ___

A

Laminar

143
Q

Turbulence occurs at…

A

Higher flow rates or when there are changes in the air passageway (i.e.: airway branches/diameter/velocity/direction changes)

144
Q

Laminar flow is…

A

Parallel streams of flow

145
Q

Velocity in the center of the airway is ___ than at the edges of the tube

A

Twice as fast

146
Q

Poiseuille’s Law

A

Describes resistance to flow through a tube

147
Q

Poiseuille’s law—pressure increases proportional to ___ and ___

A
  • flow rate

- gas viscosity

148
Q

Poiseuille’s Law—___ and ___ increase flow resistance

A
  • smaller airway radius

- longer distances

149
Q

PL—Higher flow rate = ___ pressure

A

Higher pressure

150
Q

PL—Higher viscosity = ___ pressure

A

Higher pressure

151
Q

PL—smaller radius = ___ resistance

A

Greater

152
Q

PL—longer distance = ___ resistance

A

Greater

153
Q

PL—reducing the radius by 16% will ___ the resistance

A

Double the resistance

154
Q

PL—reducing the radius by 50% will ___ resistance

A

Increase resistance 16-fold

155
Q

Ohm’s Law

A

Pressure = Flow x Resistance

Resistance = Pressure / Flow

156
Q

Turbulent flow occurs at ___

A

Higher flow rates

157
Q

Increases in what 3 things can cause turbulent flow?

A

Increases in…

  • density
  • velocity
  • airway resistance
158
Q

What is the chief site of airway resistance?

A

The medium-sized bronchi

159
Q

Very small bronchioles have ___ resistance

A

Very little

160
Q

Air velocity in the small bronchioles is ___

A

Low; diffusion takes over

161
Q

What are 3 factors that determine airway resistance?

A
  • Lung volume
  • Bronchial smooth muscle
  • Density and viscosity of inspired gas
162
Q

As lung volume is reduced, airway resistance ___

A

Increases

163
Q

Contraction of bronchial smooth muscle (bronchoconstriction) ___ resistance

A

Increases

164
Q

Higher gas density ___ resistance

A

Increases resistance to flow

165
Q

Higher viscosity = ___ resistance

A

Increased

166
Q

What has more influence on resistance of flow—density or viscosity?

A

Density

167
Q

What can we use to determine the work of breathing?

A

Oxygen consumption measurements

168
Q

O2 cost of quiet breathing

A

5% of total resting oxygen consumption

169
Q

O2 cost of hyperventilation

A

30% oxygen consumption

170
Q

O2 cost in obstructive lung disease

A

High O2 cost limits exercise ability