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Anatomy exam 3 > limbiks_Exam 3 Lecture 2 > Flashcards

limbiks_Exam 3 Lecture 2 Flashcards

1
Q

Where is the vast majority of oxygen found in the blood?

A

Hemoglobin

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2
Q

In what forms does CO2 float around in the blood?

A

Bicarbonate and carbon amino compound

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3
Q

What is the composition of the first portion of expired air?

A

No nitrogen

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4
Q

What is the significance of the appearance of N2 during expiration?

A

Transitional phase

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5
Q

How can we estimate anatomical dead space during expiration?

A

No nitrogen and halfway to midpoint of transitional phase

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6
Q

What is the rule of thumb for determining anatomical dead space?

A

1 cc per pound of body mass

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7
Q

How much anatomical dead space does a 70 kg (approximately 150 pounds) person have?

A

150 cc’s

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8
Q

Does being overweight or obese add any anatomical dead space?

A

No

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9
Q

What primarily affects the amount of anatomical dead space a person has?

A

Overall size of the frame/body size

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10
Q

What information can be obtained by plotting volume on one axis and air flow speed on the other axis?

A

Useful info about vital capacity

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11
Q

What is the concern regarding peak expiratory flow rate during expiration?

A

Total lung capacity

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12
Q

What happens to the airflow rate during this process?

A

Picks up very quickly

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13
Q

What is the reason behind having a lung volume just below total capacity?

A

Effort, elastic recoil of the lung, surface tension

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14
Q

When are the airways about as open as they’re going to be?

A

At very high lung volume

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15
Q

What happens with higher lung volume?

A

Fuller alveoli and wider airways

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16
Q

Why is there rapid movement of air out of the system at TLC?

A

Fuller alveoli and wide airways

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17
Q

How fast can the air move out of the system at TLC for an average person?

A

About 10 liters per second

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18
Q

What is the ratio that is used to assess lung function?

A

FEV1 / FVC

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19
Q

What is the normal value for the FEV1 / FVC ratio?

A

80%

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20
Q

What does a lower FEV1 / FVC ratio indicate?

A

Obstructive lung disease

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21
Q

What does a higher FEV1 / FVC ratio indicate?

A

Restrictive lung disease

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22
Q

How does the FEV1 / FVC ratio change in restrictive lung disease?

A

It doesn’t change much

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23
Q

What does a lower low ratio imply?

A

Obstruction like asthma or Zima

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24
Q

When are we typically worried about obstructions?

A

On expirations

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25
Q

Main concern:

A

Obstructions

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26
Q

Obstructions can be:

A

Fixed or nonfixed

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27
Q

Fixed vs nonfixed:

A

Inside/outside chest

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28
Q

What does an extra thoracic obstruction represent in a drawing of the trachea?

A

Problem outside the chest

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29
Q

What does an intra thoracic obstruction represent in a drawing of the trachea?

A

Problem inside the chest

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30
Q

What is the characteristic of most obstructions in the respiratory system?

A

Variable

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31
Q

What type of obstructions are the vast majority of variable obstructions?

A

Intra thoracic

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32
Q

Problem with asthma attack?

A

Expiring

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33
Q

Problem with variable intra thoracic obstruction

A

Expiration

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34
Q

Reason for expiration being a problem?

A

Intra thoracic obstruction is an airway obstruction

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35
Q

Reason for force affecting airways?

A

Force applied to get air out of lungs

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36
Q

Why is a lack of connective tissue or springs in airways a significant problem?

A

Vulnerable to collapse

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37
Q

When are the airways more vulnerable to collapse?

A

Forced expiration

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38
Q

What happens if there is a variable intra thoracic obstruction during inspiration?

A

No problems on inspiration

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39
Q

What pulls an obstruction out of the way during inspiration?

A

Negative pressure

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40
Q

Where is the negative pressure generated that can pull an obstruction out of the way?

A

In the chest

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41
Q

What type of obstruction is affected by negative pressure pulling it out of the way?

A

Intra thoracic obstruction

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42
Q

What does a variable intra thoracic obstruction cause concern for?

A

Selective compression or resistance to outflow during expiration, specifically forced expiration

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43
Q

What is another type of obstruction besides intra thoracic?

A

Extra thoracic obstruction

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44
Q

What is an example of an extra thoracic obstruction that is variable?

A

Paralyzed vocal cords

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45
Q

What happens to the airways during negative pressure breathing?

A

Pulled open

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46
Q

What happens when there is a paralyzed vocal cord and negative airway pressure?

A

Obstruction during inspiration

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47
Q

During expiration, what happens with a variable extrathoracic obstruction?

A

Positive intrathoracic pressure pushes obstruction out of the way

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48
Q

What type of obstruction is a problem on inspiration?

A

Not expiration

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49
Q

What is an example of a fixed obstruction?

A

Endotracheal tube

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50
Q

What effect does an endotracheal tube have on the trachea?

A

Creates a fixed obstruction

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51
Q

Why does an endotracheal tube affect both inspiration and expiration?

A

It has a fixed inner diameter

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52
Q

Where is the problem indicated in a flow volume loop due to an endotracheal tube?

A

Both inspiration and expiration

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53
Q

What is an example of a fixed intra or extra thoracic obstruction?

A

Endotracheal tube

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54
Q

How are the peak inspiratory and expiratory flow rates limited in fixed obstructions?

A

Straight line

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55
Q

What does a variable extra thoracic obstruction affect?

A

Inspiration

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56
Q

What does a variable intra thoracic obstruction affect?

A

Expiration

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57
Q

What axis on a flow-volume loop shows airflow?

A

Liters per second

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58
Q

What axis on a flow-volume loop shows volume?

A

Time

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59
Q

Can a flow-volume loop be plotted without a time axis?

A

Yes

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60
Q

What should a normal person have lost about after one second of a forced expiratory maneuver from total lung capacity?

A

80% of the vital capacity

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61
Q

How much volume should a normal person have exhaled by the first second of the maneuver?

A

about 4 liters

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62
Q

What is the ratio of FEV1 over FVC for this person?

A

80%

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63
Q

What does the total volume loss during expiration tell us about?

A

The vital capacity

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64
Q

What are the two main differences in the tracing of the sick patient compared to a normal person?

A

Lower vital capacity and lower forced expiratory volume

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65
Q

What is the normal vital capacity for a person?

A

Four and a half liters

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66
Q

What is the vital capacity of the sick patient in the tracing?

A

3 liters

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67
Q

How does the forced expiratory volume of the sick patient compare to a normal person?

A

Substantially lower

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68
Q

How many Liters should a normal person be able to get out?

A

3.5 Liters

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69
Q

What is the measured amount mentioned in the text?

A

3.6 liters

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70
Q

What was the estimated amount mentioned by the speaker?

A

4 liters

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71
Q

What is the FEV1 of a person with serious airway obstructions?

A

1.5 Liters

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72
Q

What is the FVC of a person with serious airway obstructions?

A

3 Liters

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73
Q

What is the normal FEV1/FVC ratio?

A

80%

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74
Q

What is the FEV1/FVC ratio of a person with serious airway obstructions?

A

50%

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75
Q

How long does it take to exhale the first 1.5 Liters of air in a person with serious airway obstructions?

A

1 second

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76
Q

How long does it take to exhale all the air in a person with serious airway obstructions?

A

7 seconds

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77
Q

What is considered the lower limit of normal for FEV1/FVC ratio?

A

0.5

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78
Q

What is the FEV1/FVC ratio for the first person?

A

76%

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79
Q

What is the vital capacity for the second person?

A

3 L

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80
Q

What is the FEV1 for the second person?

A

2.5 L

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81
Q

What is the FEV1/FVC ratio for the second person?

A

83%

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82
Q

What is the characteristic feature of restrictive lung disease on pulmonary function tests?

A

Low vital capacity, normal FEV1/FEVn ratio

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83
Q

How does vital capacity change in restrictive lung disease?

A

It is low

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84
Q

What is the ratio when dividing 1.75 L by 2 L?

A

87%

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85
Q

What does a normal or high ratio usually indicate in lung function?

A

Restrictive lung disease

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86
Q

What disorder is likely indicated by an altered flow volume loop?

A

Obstructive disorder

87
Q

What is the normal peak expiratory flow rate?

A

10 L

88
Q

What is the peak expiratory flow rate?

A

About 3L

89
Q

How much air is exhaled in the first second?

A

1.5 L

90
Q

How is the patient’s vital capacity described?

A

Lower than normal

91
Q

What observation is made about the rest of the vital capacity coming out?

A

Takes an awful long time

92
Q

What is an indicator of obstructive lung disease?

A

Lower FEV1 than normal

93
Q

What is the normal range for FEV1?

A

3.8 - 4

94
Q

What does a lower than normal FEV1 indicate?

A

Obstructive lung disease

95
Q

In COPD, what lung function test is consistently abnormal?

A

FEV1

96
Q

What is expected when FEV1 is low?

A

FEV1/FVC ratio to be low

97
Q

What change do we typically see with TLC in COPD?

A

TLC should be elevated

98
Q

COPD

A

RV, FRC increased

99
Q

Restrictive disease (Fibrosis)

A

FEV1, FVC decreased

100
Q

What do the flow volume loops in the Guyton review manual show?

A

Different levels of effort

101
Q

What does the biggest loop effort ‘W’ indicate in a flow volume loop?

A

RV up to total lung capacity

102
Q

What do increasing curves on a flow volume loop represent?

A

Deeper breaths

103
Q

What does the smallest curve on a flow volume loop represent?

A

Smallest tidal volume

104
Q

What is shown in the top part of a flow volume loop?

A

Tidal volumes

105
Q

What is depicted on the left side of the flow volume loop?

A

Time course of force expiration

106
Q

How can one determine the depth of breath from a flow volume loop?

A

By the size of the curve

107
Q

What does a deeper curve indicate on a flow volume loop?

A

Deeper breaths

108
Q

How many liters have come out of the patient?

A

3 liters

109
Q

What is the vital capacity at total lung capacity?

A

5 liters

110
Q

At what point has 3 liters of air been squeezed out by the green line?

A

One second mark

111
Q

How many liters of air has each person exhaled?

A

3

112
Q

What might the FEV1/FVC ratio indicate if it’s normal?

A

Green, Restrictive lung disease.

113
Q

What do the pictures show?

A

Patient’s air exhalation.

114
Q

What does the FEV1/FVC test measure?

A

Lung emptying speed.

115
Q

When might the lung emptying process be interfered with?

A

Patient sickness.

116
Q

What percentage of atmospheric nitrogen should be in the air?

A

79%

117
Q

What is the nitrogen concentration in the lungs after displacement by water vapor?

A

75%

118
Q

How much pressure of water vapor is in the lungs?

A

47 mmHg

119
Q

What would happen if we breathed 100% oxygen?

A

Dilute nitrogen in lungs

120
Q

Amount of dilution in each breath

A

Alveolar portion of tidal volume

121
Q

Nitrogen concentration in a set of lungs

A

75%

122
Q

Time to remove all nitrogen from lungs

A

Long

123
Q

What nitrogen concentration should a healthy person be able to achieve in the lungs in seven minutes of breathing?

A

2.5%

124
Q

How many minutes of breathing should it take for a healthy person to reach the 2.5% nitrogen concentration in the lungs?

A

seven

125
Q

How does COPD affect lung nitrogen?

A

Takes longer to blow out nitrogen

126
Q

What does the blue line on the graph represent?

A

COPD patient

127
Q

What does the black line on the graph represent?

A

Healthy patient

128
Q

What do the data points on the graph represent?

A

Samples of expired air

129
Q

What is the result of uneven ventilation?

A

Blue line shows inconsistency between dots

130
Q

How would uneven ventilation affect the dilution process?

A

Takes more breaths for dilution

131
Q

What is the defining feature of unhealthy lungs in a nitrogen dilution test?

A

Uneven ventilation

132
Q

Does tidal volume affect the dilution?

A

Yes

133
Q

What plays a role in dilution along with tidal volume?

A

Lung volume

134
Q

Can lung diseases like COPD impact nitrogen washout?

A

Yes

135
Q

Which lung diseases may not have a significant effect on nitrogen washout?

A

Restrictive diseases like sarcoidosis or fibrosis

136
Q

Volume at the beginning of the transitional phase?

A

150ml expired air

137
Q

Volume of the transitional phase?

A

100cc

138
Q

What is the total expired air up until the alveolar plateau?

A

200ccs

139
Q

How much is the anatomical dead space in this case?

A

150 ccs

140
Q

Is the graph easy to understand?

A

No

141
Q

What is the Closing Capacity test?

A

A dilutional nitrogen pulmonary function test.

142
Q

What does the Closing Capacity test measure?

A

The dilutional effect of a large breath of 100% Oxygen.

143
Q

How does the Nitrogen washout method work?

A

By looking at expired nitrogen concentration after breathing 100% oxygen.

144
Q

What is the purpose of the closing capacity test?

A

Assess lung function

145
Q

What lung volumes are involved in the closing capacity test?

A

FRC to RV

146
Q

What gas is inspired during the closing capacity test?

A

100% Oxygen

147
Q

TLC

A

6 liters

148
Q

FRC

A

1.5 liters

149
Q

N2 at FRC and RV

A

75%

150
Q

N2 at TLC

A

Diluted by 100% O2

151
Q

What volume of 100% oxygen was added?

A

4.5 liters

152
Q

What was the initial total air volume?

A

1.5 liters

153
Q

What percentage of the initial volume was nitrogen?

A

75%

154
Q

How was the nitrogen concentration affected by adding oxygen?

A

Diluted out by a lot

155
Q

Typical value of nitrogen concentration after adding 4.5 L of pure oxygen to the lungs?

A

25-30%

156
Q

Method for calculating nitrogen concentration after adding oxygen

A

Add quantity of nitrogen at RV + 4.5L

157
Q

What happens to nitrogen concentration when adding oxygen

A

Decreases

158
Q

What is done after reaching total lung capacity?

A

Hook patient up to a nitrogen analyzer

159
Q

What is analyzed in the expired breath of the patient?

A

Quantity of nitrogen

160
Q

What is plotted as a function of expired air?

A

Quantity of nitrogen coming out

161
Q

What is the initial step in measuring expired gas?

A

Voluntarily exhale, inhale oxygen, inhale deeply

162
Q

What is phase three similar to in Fowler’s test?

A

Plateau phase

163
Q

What is the main difference between phase three in this test and Fowler’s test?

A

Larger expired volume

164
Q

What aspect are we more interested in during phase three of this test?

A

Other aspects of usefulness

165
Q

What is phase four in lung volume measurement?

A

Sharp upstroke of expired nitrogen

166
Q

What is the closing volume?

A

Volume of air expired during phase 4

167
Q

How is the closing volume related to ERV?

A

Very similar

168
Q

Lung Volume at Residual Volume (RV)

A

Alveoli at base: 20% full

169
Q

Lung Alveoli at RV

A

Alveoli at apex: 30% full

170
Q

Air Volume Capacity at RV

A

Alveoli at apex: 70%

171
Q

What percentage of their total capacity must be added to the bottom of the lung to achieve 100% fullness during vital capacity inspiration?

A

80%

172
Q

What percentage of their total capacity needs to be added to the top (apical) of the lung to achieve 100% fullness during vital capacity inspiration?

A

70%

173
Q

What happens when we breathe in air without nitrogen?

A

Alveoli become 100% full

174
Q

Effect of breathing extra fresh air in alveoli at the bottom of the lung?

A

Nitrogen concentration knocked down a lot

175
Q

Effect of breathing extra fresh air in alveoli at the top of the lung?

A

Nitrogen concentration diluted out but less than at the base

176
Q

Where in the lung is nitrogen concentration higher in expired air?

A

Top of the lung

177
Q

Why is nitrogen concentration lower in expired air from the base of the lung?

A

Diluted more during deep breath

178
Q

What should the initial concentration of expired nitrogen be?

A

None

179
Q

What happens after the initial phase in expired nitrogen concentration?

A

Transitional phase leading to plateau

180
Q

Does the plateau phase of expired nitrogen concentration have a slope?

A

Yes, a little

181
Q

What occurs after the plateau phase in expired nitrogen concentration?

A

Abrupt increase

182
Q

At the beginning of the plateau phase, where does most of the air come from?

A

From the base of the lung

183
Q

What happens at the end of the plateau phase?

A

Abrupt spike in expired nitrogen

184
Q

Why does the abrupt spike in expired nitrogen occur?

A

Small airways at the base of lung collapse

185
Q

What is closing volume?

A

Volume where the base of the lung starts collapsing

186
Q

What happens when the airways at the base of the lung close?

A

No nitrogen coming from those alveoli

187
Q

Why is there a larger amount of expired air from the top of the lung when the base closes?

A

Proportionate change

188
Q

Why is the base of the lung more prone to collapse in older age?

A

Loss of traction, springs, and elastic tissues

189
Q

Why is airway collapse unlikely in healthy 20 year olds?

A

Healthy lungs

190
Q

At what age does airway collapse become more common?

A

50

191
Q

Which lung airway structures are prone to collapse first during expiration?

A

Airways at base of lung

192
Q

What causes the upstroke of phase IV in Schmidt’s drawing graph?

A

Less air from base, more from top

193
Q

What might it indicate if the upstroke of phase IV occurs earlier than expected?

A

Earlier airway collapse, or reduced traction, or less elastic recoil, or more pseudo-obstructive lung disease

194
Q

What is a simple and sensitive test to assess lung health?

A

Closing volume closing capacity test

195
Q

Why is the closing volume closing capacity test preferred?

A

Quick, easy, cheap, sensitive

196
Q

How does the aging process affect lung performance?

A

Not a big deal due to safety factor

197
Q

Why is this test sensitive?

A

To airway collapse tendency

198
Q

Why is closing volume expected to be low in young individuals?

A

It should be a low number in somebody who’s young.

199
Q

What is closing capacity?

A

Combination of residual volume plus closing volume.

200
Q

How does closing capacity differ from FRC?

A

Very similar to FRC but varies more with normal aging.

201
Q

What change occurs in closing capacity as people age from 20 to 70 years old?

A

Closing capacity increases with age

202
Q

At what age is the closing capacity very close to the residual volume?

A

Age 20

203
Q

What happens to the closing capacity at the base of the lungs during normal breathing at age 20?

A

No collapsing airways

204
Q

What is the impact of age on the breathing process?

A

More laborious for older individuals

205
Q

Where is the operating range typically for airways regarding closing capacity?

A

Around FRC or above ERV line

206
Q

What happens if closing capacity exceeds FRC?

A

Airway collapse at the end of every expiration

207
Q

What happens to elastic recoil springs as we age?

A

Lose elasticity

208
Q

What happens to nephrons as we age?

A

Lose nephrons

209
Q

Increased load on the remaining nephrons can lead to what?

A

Issues

210
Q

When do most organ systems start to decline?

A

Upper 30s or 40s

211
Q

At what age do we start experiencing decline in lung function?

A

20 years

212
Q

What is the number 1 rule in medicine according to the text?

A

Don’t get sick and don’t get old.

213
Q

What happens to the closing volume as you get older?

A

Shifts towards higher lung volume

214
Q

Why do older people have difficulty breathing?

A

Work of breathing increases due to uncoordinated expiratory maneuvers.

Anatomy exam 3 (2 decks)

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