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Respiratory > Lung Physiology > Flashcards

Lung Physiology Flashcards

1
Q

What are the 5 main features of inflammation

A
  1. Calor (hot)
  2. Rubor (red)
  3. Dolor (painful)
  4. Tumour (swollen)
  5. Functio leasa (loss of function)
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2
Q

Define acute inflammation

A

Innate, intermediate and response short term followed by tissue injury

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3
Q

What is the result of vasodilation

A

Enhances blood flow to nearby capillaries and tissues

Leads to exbation of plasma including antibodies

Higher blood flow = rubor and calor

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4
Q

Define calor

A

Hot

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5
Q

Define rubor

A

Red

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6
Q

Define dolor

A

Painful

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7
Q

Define tumour

A

Swollen

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8
Q

Define functio lessa

A

Loss of function

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9
Q

In acute inflammation what are the steps of the biochemical cascades

A

Initiated in tissues by epithelial production of hydrogen peroxide and release of extracellular components

Amplified by specialist macrophages

Respond to pathogens or to tissue by recognising PAMPs or DAMPs

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10
Q

Define the meaning double edged sword

A

People die from the inflammatory process

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11
Q

What are the figures of community acquired pneumonia

Number affected each year

How many of those affected are admitted to hospital

What is the mortality of those who are admitted

A

250,000 adults per annum

33% of those are admitted to hospital

Morality approx. 10% of those admitted

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12
Q

Define ARDs (acute respiratory distress syndrome)

A

Form of acute lung injury characterised by severe hypoxemia (low blood oxygen) in the absence of a cardiogenic cause

Occurs when inflammatory damage to alveoli leads to pulmonary oedema

Can be direct or indirect

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13
Q

Define PRRs (Pattern Recognition Receptors)

A

Not specific of individual pathogens but to a group of pathogens

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14
Q

Define Toll-like receptors

A

Main PRR

Recognise different pathogen associated molecular patterns (PAMPs)

Recognise conserved molecular patterns in pathogens

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15
Q

How many toll-like receptor types are there

A

11

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16
Q

What are the two types of PRRs

A

Toll-like receptors

Nod-like receptors

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17
Q

What is the role of a macrophage

A

Critical role in immune regulation and wound healing

Can respond to a variety of cellular signals and change their physiology in response to local cues

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18
Q

What are alveolar macrophages

A

Specialised resident phagocytes

First line of cellular defence in the lungs

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19
Q

What are vital roles of alveolar macrophages

A

Lung development
Surfactant homeostasis
Immune surveillance

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20
Q

Where are alveolar macrophages located

A

Inner epithelial surface of alveoli

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21
Q

How does the respiratory epithelium act as a host defence in the lung

A

Acts as a barrier to potential pathogens

Prevents tissue injury by action of mucocillary escalator

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22
Q

What are the chemical epithelial barriers

A

Produced by most epithelial cells

  • Antiproteases
  • Anti-fungal peptides
  • Anti-microbial peptides
  • Anti-viral proteins
  • Opsins
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23
Q

How does alveolar epithelium have host defence function

A

Epithelial cells produce physical barriers (mucus) and products of submucosal glands

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24
Q

What is the role of mucus in the lungs

A

Viscoelastic gel - contains carbohydrates, proteins and lipids

Protects epithelium from foreign material

Prevents fluid loss

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25
Q

How does the mucocillary escalator work

A

Cilia beat in directional waves to move mucus up the airway

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26
Q

Define cough

A

Expulsive reflex that protects the lungs and respiratory passages from foreign bodies

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27
Q

What causes coughs

A

Irritants
Disease conditions
Infections

Can be voluntary or reflexively

As a defensive reflex has both afferent and efferent pathways

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28
Q

What are the afferent nerves of the cough relfex

A

Receptors - within the sensory of trigeminal, glossopharyngeal, superior laryngeal and Vagus nerves

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29
Q

What are the efferent nerves of the cough reflex

A

Recurrent laryngeal nerve and spinal nerves

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30
Q

Define sneeze

A

Involuntary expulsion of air containing irritants from nose

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31
Q

What are the causes of a sneeze

A

Irritation of nasal mucosa

Excess fluid in airway

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32
Q

Define complete repair

A

Following injury of airway epithelium it can fully repair due to a level of funtioning plasticity

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33
Q

What are mucus plugs associated with

A

Severe disease

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34
Q

What is the requirements of the respiratory pump

A

To move 5L/min of inspired gas (match cardiac output 5L/min)

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35
Q

What are the nerves involved in respiratory pump

A

Sensory
- Sensory receptors
- C fibres
- Afferent via Vagus nerve

Autonomic - sympathetic, parasympathetic balance

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36
Q

Define compliant

A

Lungs ability to stretch and expand

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37
Q

What is the role of surface tension

A

Limits the compliance of the lungs

Thin layer of water due to water interactions try to push air out which avoids the alveoli from collapsing

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38
Q

What is the total combined surface area for gas exchange

A

50 -100m2

39
Q

How many alveoli are there per each lung

A

300,000,000

40
Q

What is needed for gas exchange

A

Perfusion

41
Q

What are the two factors which effect gas exchange

A

Ventilation
Perfusion

42
Q

Define dead space

A

Volume of air not contributing to ventilation

Last bit of gas we breath in which does not contribute to gas exchange e.g. in the nasopharynx

43
Q

What is the volume of anatomic dead space

A

150 mls

44
Q

What is the volume of alveolar dead space

A

25 mls

45
Q

What is the volume of physiological dead space

A

175 mls

anatomic + alveolar

46
Q

What is the artery supply to the lungs

A

Bronchial arteries (arise from the descending aorta)

47
Q

What must both right and left ventricles have

A

Same cardiac output

Prevent blood from building up in either systemic or pulmonary circulation

48
Q

What does the right bronchial vein drain into

A

Azygous veins

49
Q

What does the left bronchial vein drain into

A

Accessory hemizygous veins

50
Q

Define pulmonary circulation

A

Carries deoxygenated blood away from the heart to the lungs’ alveoli to undergo gas exchange and return oxygenated blood back to the heart

51
Q

How many pulmonary veins are there

A

4

2 per lung

52
Q

Define broncho-vascular bundle

A

Pulmonary artery and bronchus run in parallel

53
Q

How many capillaries are there per alveolus

A

100

54
Q

How many erythrocytes will come into contact alveoli

A

Multiple

55
Q

At rest what % way through the capillary is the haemoglobin fully saturated

A

25%

56
Q

What are the 3 things capillaries must have to promote efficient gas exchange

A

Large surface area available for gas exchange

Short diffusion distance (combined 0.3 um)

Hypoxic pulmonary vasoconstriction - Ventilation matching

57
Q

What does perfusion of capillaries depend on

A

Pulmonary artery pressure
Pulmonary venous pressure
Alveolar pressure

58
Q

What is the mean arterial pressure of the pulmonary circulation

A

5-15mmHg (Low)

59
Q

What is the mean arterial pressure of the systemic circulation

A

93 mmHg

60
Q

What features do pulmonary arteries have to allow them to carry more blood

A

Thin vascular walls
High compliance

61
Q

What is the optimal V/Q ratio

A

0.8-1

62
Q

Define hypoxic pulmonary vasoconstriction

A

Small arteries constrict to redirect blood flow from poorly ventilated areas of the lung to better ventilated areas

63
Q

What does recruiting of alveoli occur in

A

Exercise

64
Q

What % capacity of cardiac output do pulmonary vessels have at rest

A

30%

65
Q

Define spirometry

A

Method of measuring the volume of air that the patient is able to expel from lungs after maximal inspiration

66
Q

Define FEV1
(Forced expiratory volume in one second)

A

Volume exhaled in the first second after deep inspiration and forced expiration

67
Q

Define FVC
(Forced vital capacity)

A

Total volume of air that a patient can forcibly exhale in one breath

68
Q

What are FEV1 and FVC expressed as

A

% predicted normal of a person of the same age, sex and height

69
Q

What does a peak flow give readings in

A

litres/minute (L/min)

70
Q

What can expiratory procedures only measure

A

Vital capacity not residual volume

71
Q

What methods can be used to measure residual volume

A

Gas dilution
Body box (total body plethysmography)

72
Q

What does gas dilutions measure

A

Measurement of all air in the lungs that communicates with the airways

73
Q

What does helium dilutions measure

A

Measures the total lung capacity (only accurate if the lungs are not obstructed)

Quite inspiration holds gas of known helium conc.
Hold breath for 10 seconds (allows air to mix with lungs)
Conc. of helium measured after expiration

74
Q

What does nitrogen wash out measure

A

Calculates the serial/anatomical dead space in the conducting airways including terminal bronchioles (normally 150mL)

75
Q

What does total body plethysmography measure

A

Lung volume, including gas trapped in bullae

Patient pants, pressure is proportionate to air in the chest

76
Q

How do you measure compliance of lungs

A

Change in volume per unit change in pressure gradient between the pleura and the alveoli (transpulmonary pressure)

During breath hold - static compliance
During regular breathing - dynamic compliance

77
Q

What is static compliance a measure of

A

Distensibility

78
Q

How would you measure dynamic compliance

A

Measured during tidal breathing at the end of inspiration and expiration when stationary

79
Q

What are the three importance of respiration

A
  1. Ensure haemoglobin is close to saturation of oxygen as possible
  2. Efficient use of energy resource
  3. Regulate PaCO2 carefully (impacts pH)
80
Q

What is the major determinant of next breath

A

CO2

81
Q

What is CO2 inversely proportional to

A

Alveolar ventilation

82
Q

What are the three types of lung receptors

A

Stretch
J
Irritant

83
Q

What are the roles of lung receptors

A

Assist with lung volumes and responses to noxious inhaled agents

84
Q

What are the airway receptors in the nose, nasopharynx and larynx

A

Chemo and mechano receptors

85
Q

What are the role of the airway receptors in the pharynx

A

Receptors appear to be activated by swallowing

Respiratory activity stops during swallowing to protecting against the risk of aspiration of food or liquid

86
Q

What is the normal PaCO2

A

4-6 KPa

87
Q

If alveoli ventilation increase what happens to CO2

A

Decreases

(Vice versa)

88
Q

Define respiratory failure

A

Failure of gas exchange

Low PaO2 (with or without a rise in PaCO2)

89
Q

Define hypoxia vs hypoxemia

A

Tissue components vs ambient low-pressure environment

90
Q

What is piO2 at sea level

A

21 KPa

100KPa x 0.21

91
Q

Define PAO2

A

Alveolar

92
Q

Define PaO2

A

Arterial

93
Q

Define type 1 respiratory failure

A

PaO2 = low (hypoxia)
PaCO2 = low/abnormal (hypocapnia/normal)

94
Q

Define type 2 respiratory failure

A

PaO2 = low (hypoxia)
PaCO2 = high (hypercapnia)

Respiratory (16 decks)

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