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DPT732: MAP II > MAPII Final > Flashcards

MAPII Final Flashcards

1
Q

What are the 5 major functions of respiration?

A
  1. Pulmonary Ventilation
  2. External Respiration
  3. Transport of respiratory gasses
  4. Internal Respiration
  5. Regulation of ventilation/respiration
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2
Q

What are the 5 major functions of respiration?

A
  1. Pulmonary Ventilation
  2. External Respiration
  3. Transport of respiratory gasses
  4. Internal Respiration
  5. Regulation of ventilation/respiration
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3
Q

How many lobes does the right lobe consist of? Left?

A 
Right = 3
Left = 2
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4
Q

The lungs occupy all of thoracic cavity except the

A

mediastinum

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5
Q

What tissue type are the lungs made of and why?

A

elastic connective tissue, helps reduce work of breathing.

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6
Q

Where do the lungs receive their blood supply from? What is the route of the artery? What percentage of the cardiac output is taken to the heart?

A

Bronchial Arteries - off aorta, enter lungs through hilum. 1-2% of cardiac output goes through here.

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7
Q

What removes the blood supply form the lungs? What is the route of the vein? What is the significance of this route?

A

Pulmonary Veins - carry deoxygenated blood back to left atrium

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8
Q

What is the function of the parasympathetic nervous system on respiration?

A
  • Constriction of air tubes
  • ACH released –> smooth muscle contraction
  • Increased airway resistance
  • Slows and reduces volume of airflow.
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9
Q

What is the function of the sympathetic nervous system on respiration?

A
  • Dilation of air tubes
  • Weak Direct control
  • Strong effect by Epi and NE released in blood from adrenal medulla
  • ->smooth muscle relaxation
  • Reduces airway resistance –> enhances flow
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10
Q

Intrapleural pressure is ___ so is (negative/positive) pressure compared to atmospheric?

A

Intrapleural pressure: 756mmHg
Atmospheric 760mmHg

-4mmHg: Negative pressure difference

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11
Q

The airways are broken up in what to tracts?

A

Upper Respiratory Tract

Lower Respiratory Tract

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12
Q

What is the start and end of the Upper Respiratory Tract? What consists of the upper respiratory tract?

A

From nasal and oral orifices –> false vocal cords in larynx

Nose
Nasal Cavity
Pharynx (naso, oro, laryngo)
Larynx

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13
Q

What is the start and end of the Lower Respiratory Tract?

A

From level of true vocal cords to alveoli

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14
Q

What is the Lower Respiratory Tract divided into? What volume are the zones?

A

Conducting Zone - 150mL

Respiratory Zone

  • 2.5L at Rest
  • Up to 4-6 w/ max inspiration
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15
Q

What makes up the conducting zone?

A 
Trachea
R + L Primary Bronchi
Secondary Bronchi
Tertiary Bronchi
Bronchioles
Terminal Bronchios
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16
Q

T/F: No gas exchange is done in the conducting zone.

A

True

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17
Q

At what level does the Trachea bifurfacte and what type of cells is it made up of? What is their function?

A

Bifurcates @ T7. Made up of columnar cells that secrete mucus to catch stuff on way down. The cilia move it.

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18
Q

Is the right of left primary bronchi more vertical? What is the clinical significance of this?

A

Right is more vertical than Left. Right is more common site for inhaled foreign body.

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19
Q

How many secondary-lobar bronchi are there on the right and left?

A

3 on the Right

2 on the left

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20
Q

How many order of branching do the tertiary-segmental bronchi have?

A

approx 23

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21
Q

In a normal patient, do smaller or larger bronchioles provide greats amount of resistance to airflow? Disease conditions?

A

Normal: larger bronchioles near trachea provide greatest amount of resistance to airflow.

Disease Conditions: smaller bronchioles provide greatest resistance to airflow.

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22
Q

Roughly what diameter are Terminal Bronchioles? Does gas exchange occur here?

A
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23
Q

What structures does the respiratory zone consist of?

A

Respiratory bronchioles
Alvelor duct
Alveolar sacs
Alveoli

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24
Q

What type of cells are the walls of alveoli made up of? What are these cells surrounded by? What are the external surface of the alveolar walls covered by?

A

Walls are type 1 cells: single layer of squamous epithelial cells.

Surrounded by basement membrane.

Ext. surface covered by web of capillaries.

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25
Q

What makes up the Respiratory Membrane?

A

Alveolar walls + Capillary Walls + fused basement membrane.

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26
Q

At rest perminute, what volume of O2 leave alveoli to blood, and what volume of CO2 diffuse from blood to gas in alveoli?

A

@ rest / min:

  • 250ml of O2 leave alveoli to blood
  • 200ml of CO2 diffuse from blood to gas in alveoli
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27
Q

What is the function of Type 2 cells?

A

secrete surfactant

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28
Q

What do pores in the alevoli allow for?

A

nutrient transport

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29
Q

How does pulmonary edema affect respiration?

A

Effects diffusion (rate of diffusion through tissue water is the limiting factor in transport)

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30
Q

What is anatomical dead space? What is physiological dead space and how does it compare?

A

Dead Space: No gas exchange

Anatomical: Conducting Zone + Upper Airway: vol of all space of respiratory system other than alveoli and closely related gas exchange areas.

Physiological: Alveolar dead space (includes non functional alveoli)

Health Individual: anatomical = physiological

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31
Q

How is pulmonary ventilation defined?

A

movement of air into and out of lungs = breathing

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32
Q

What percentage of total body expenditure is required for pulmonary ventilation? What is the clinical significance of this?

A

3-5%

this percentage will increase with exercise so can train inspiritory muscles to make efficient.

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33
Q

During quiet inspiration, what is the primary muscle used and how does it affect thoracic volume?

A

Primary = contraction of diaphragm from dome shape to flattened.

Increases thoracic volume in superior to inferior dimension.

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34
Q

During forced inspiration what muscles are used and how do they affect thoracic volume?

A

Elevation of the ribs:

-External intercostals: lift rib cage and pull sternum superiorly. Lateral and Anterior-Posterior expansion of thoracic cavity.

SCM, Scalenes, Anterior Serratus, Pec Minor, Errector Spinae

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35
Q

During quiet expiration, what muscles are used and how do they affect thoracic volume?

A

relaxation of diaphragm from flattened to dome shape.

Rib cage resume resting position, lungs recoil. Decrease thoracic and intrapulmonary vol compression alveoli.

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36
Q

During forced expiration, what muses are used?

A

additional muscles are recruited for depression of ribs with increased respiratory demands/forced expriation

internal intercostals and rectus abdominus

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37
Q

Respiratory pressure is always described relative to

A

atmospheric pressure

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38
Q

What does boyle’s law indicate?

A

at constant temp, pressure of gas varies inversely volume

P1V1 = P2V2

Increase in volume –> decrease in pressure

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39
Q

What is atmospheric pressure Patm?

A

760mmHg @ sea level

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40
Q

During inspiration, Palv drops to ___ H2O. What does this allow?

A

~-1cm H2O

enough to allow 500ml of air to be pulled into the lungs in ~2 seconds

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41
Q

During expiration: Palv raises to __ H2O. What does this allow?

A

~1cm H2O

drives air out of alveoli in ~2-3 seconds

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42
Q

What is intrapleural cavity pressure in relation to Patm? Why is it negative?

A

-4mmHg

You have 2 forces trying to pull lungs away from thorax wall which would cause the lung to collapse.

  1. Lungs natural recoil tendency
  2. Surface tension of alveolar fluid

Opposed by elasticity of chest wall and maintaining pleural fluid adhesive force.

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43
Q

What is transpulmonry pressure and why is it important?

A

Palv - Pip = difference between alveolar pressure and pleural pressure.

Fxn: to keep air spaces of lungs open.

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44
Q

What is atelectasis?

A

lung collapse or part (alveoli)

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45
Q

What is pneumothroax?

A

air in intrapleural space.

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46
Q

What is lung compmliance and what determines it?

A

measure of change in lung volume that happens with a given change in transpulmonary pressure.

Determined by:

  1. distensibility - elastic forces of lung tissue
  2. Alveolar Surface Tension - surfactant (decreases)
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47
Q

In smaller alveoli, what is the greater alveolar pressure caused by?

A

surface tension (decreased by surfactant)

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48
Q

What is surfactant made up of and what function does it serve?

A

Produced by Type II cells, made of phospholipids, proteins, and ions.

Reduces surface tension which reduces effort required by respiratory muscles to expand lungs.

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49
Q

What affect does interstitial lung disease have on distensibility?

A

reduces it

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50
Q

Does an alvoli collapse due to increase or decrease in distensibility.

A

decreased distensibility

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51
Q

What is TV? About how many ml is it?

A

Tidal Volume - Amount of air inhaled/exhaled w/ breathing under resting conditions. ~500ml

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52
Q

What is IRV?

A

Inspiratory Reserve Volume - Amount of air that can be forcefully inhaled after normal TV exhalation

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53
Q

What is ERV?

A

Expiratory Reserve Volume - Amount of air that can be forefully exhaled after normal tidal volume exhalation.

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54
Q

What is RV?

A

Residual Volume - Amount of air remaining in lungs after forced exhalation.

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55
Q

What is TLC?

A

Total Lung Capacity - Max amount of air contained in the lungs after max inspiritory effort.

TLC = TV + IRV + ERV + RV

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56
Q

What is VC?

A

Vital Capacity - max amount of air that can be expired after max inspiritory effort.

VC = TV + IRV + ERV

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57
Q

What is IC?

A

Inspiratory Capacity - max amount of air that can be inspired after normal expiration.

IC = TV + IRV

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58
Q

What is FRC?

A

Functional Residual Capacity - Volume of air remaining in the lungs after normal TV expiration.

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59
Q

What is FVC?

A

Forced Vital Capaity - Max vol of air exhaled during forced maneuver.

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60
Q

What is FEV1?

A

Forced expired volume in 1 second. Measure of how quickly lungs emptied.

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61
Q

How do you calculate VA?

A

VA = Frequency * (VT - VD)

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62
Q

How do you calculate VA?

A

VA = Frequency * (VT - VD)

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63
Q

How many lobes does the right lobe consist of? Left?

A 
Right = 3
Left = 2
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64
Q

The lungs occupy all of thoracic cavity except the

A

mediastinum

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65
Q

What tissue type are the lungs made of and why?

A

elastic connective tissue, helps reduce work of breathing.

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66
Q

Where do the lungs receive their blood supply from? What is the route of the artery? What percentage of the cardiac output is taken to the heart?

A

Bronchial Arteries - off aorta, enter lungs through hilum. 1-2% of cardiac output goes through here.

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67
Q

What removes the blood supply form the lungs? What is the route of the vein? What is the significance of this route?

A

Pulmonary Veins - carry deoxygenated blood back to left atrium

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68
Q

What is the function of the parasympathetic nervous system on respiration?

A
  • Constriction of air tubes
  • ACH released –> smooth muscle contraction
  • Increased airway resistance
  • Slows and reduces volume of airflow.
How well did you know this?
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69
Q

What is the function of the sympathetic nervous system on respiration?

A
  • Dilation of air tubes
  • Weak Direct control
  • Strong effect by Epi and NE released in blood from adrenal medulla
  • ->smooth muscle relaxation
  • Reduces airway resistance –> enhances flow
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70
Q

Intrapleural pressure is ___ so is (negative/positive) pressure compared to atmospheric?

A

Intrapleural pressure: 756mmHg
Atmospheric 760mmHg

-4mmHg: Negative pressure difference

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71
Q

The airways are broken up in what to tracts?

A

Upper Respiratory Tract

Lower Respiratory Tract

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72
Q

What is the start and end of the Upper Respiratory Tract? What consists of the upper respiratory tract?

A

From nasal and oral orifices –> false vocal cords in larynx

Nose
Nasal Cavity
Pharynx (naso, oro, laryngo)
Larynx

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73
Q

Net rate of diffusion of a dissolved gas through fluid is determinant on

A
  1. Pressure difference
  2. Solubility of gas in fluid
  3. Cross Sectional Area of fluid
  4. Distance gas must diffuse
  5. Molecular weight of gas (lighter = faster)
  6. Temperature of fluid (constant in this case)
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74
Q

What is the Lower Respiratory Tract divided into? What volume are the zones?

A

Conducting Zone - 150mL

Respiratory Zone

  • 2.5L at Rest
  • Up to 4-6 w/ max inspiration
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75
Q

What makes up the conducting zone?

A 
Trachea
R + L Primary Bronchi
Secondary Bronchi
Tertiary Bronchi
Bronchioles
Terminal Bronchios
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76
Q

T/F: No gas exchange is done in the conducting zone.

A

True

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77
Q

At what level does the Trachea bifurfacte and what type of cells is it made up of? What is their function?

A

Bifurcates @ T7. Made up of columnar cells that secrete mucus to catch stuff on way down. The cilia move it.

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78
Q

Is the right of left primary bronchi more vertical? What is the clinical significance of this?

A

Right is more vertical than Left. Right is more common site for inhaled foreign body.

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79
Q

How many secondary-lobar bronchi are there on the right and left?

A

3 on the Right

2 on the left

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80
Q

How many order of branching do the tertiary-segmental bronchi have?

A

approx 23

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81
Q

In a normal patient, do smaller or larger bronchioles provide greats amount of resistance to airflow? Disease conditions?

A

Normal: larger bronchioles near trachea provide greatest amount of resistance to airflow.

Disease Conditions: smaller bronchioles provide greatest resistance to airflow.

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82
Q

Roughly what diameter are Terminal Bronchioles? Does gas exchange occur here?

A
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83
Q

What structures does the respiratory zone consist of?

A

Respiratory bronchioles
Alvelor duct
Alveolar sacs
Alveoli

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84
Q

What type of cells are the walls of alveoli made up of? What are these cells surrounded by? What are the external surface of the alveolar walls covered by?

A

Walls are type 1 cells: single layer of squamous epithelial cells.

Surrounded by basement membrane.

Ext. surface covered by web of capillaries.

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85
Q

What makes up the Respiratory Membrane?

A

Alveolar walls + Capillary Walls + fused basement membrane.

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86
Q

At rest perminute, what volume of O2 leave alveoli to blood, and what volume of CO2 diffuse from blood to gas in alveoli?

A

@ rest / min:

  • 250ml of O2 leave alveoli to blood
  • 200ml of CO2 diffuse from blood to gas in alveoli
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87
Q

What is the function of Type 2 cells?

A

secrete surfactant

88
Q

What do pores in the alevoli allow for?

A

nutrient transport

89
Q

What is the PO2 and PCO2 for:

Exhaled air?

A 
PO2 = 120
PCO2 = 27
90
Q

What is anatomical dead space? What is physiological dead space and how does it compare?

A

Dead Space: No gas exchange

Anatomical: Conducting Zone + Upper Airway: vol of all space of respiratory system other than alveoli and closely related gas exchange areas.

Physiological: Alveolar dead space (includes non functional alveoli)

Health Individual: anatomical = physiological

91
Q

How is pulmonary ventilation defined?

A

movement of air into and out of lungs = breathing

92
Q

What percentage of total body expenditure is required for pulmonary ventilation? What is the clinical significance of this?

A

3-5%

this percentage will increase with exercise so can train inspiritory muscles to make efficient.

93
Q

During quiet inspiration, what is the primary muscle used and how does it affect thoracic volume?

A

Primary = contraction of diaphragm from dome shape to flattened.

Increases thoracic volume in superior to inferior dimension.

94
Q

During forced inspiration what muscles are used and how do they affect thoracic volume?

A

Elevation of the ribs:

-External intercostals: lift rib cage and pull sternum superiorly. Lateral and Anterior-Posterior expansion of thoracic cavity.

SCM, Scalenes, Anterior Serratus, Pec Minor, Errector Spinae

95
Q

What is the PO2 at:

  • ISF surrounding Tissue
  • Tissue
  • Bronchial Arteries
A

ISF Surrounding Tissue = 40mmHg

Tissue = 5-40mmHg (avg. 23)
-Determined by rate of O2 transport to tissue and rate @ which O2 used.

Bronchial Arteries = 95mmHg
-Supply deep tissues of lungs and don’t come into contact w/ lung air and then returned by pulm veins to L atrium. 2% of blood flow that never comes into contact with alveoli.

96
Q

During forced expiration, what muses are used?

A

additional muscles are recruited for depression of ribs with increased respiratory demands/forced expriation

internal intercostals and rectus abdominus

97
Q

HgB transports what percentage of O2 from lungs to tissues? How much additional O2 transport does this allow?
How is the rest carried?

A

97% - allows transport of 30-100x amount of O2 than if O2 was just transported in dissolved gas in water of blood.

3% is carried in H2O of plasma and RBCs

98
Q

What does boyle’s law indicate?

A

at constant temp, pressure of gas varies inversely volume

P1V1 = P2V2

Increase in volume –> decrease in pressure

99
Q

What is atmospheric pressure Patm?

A

760mmHg @ sea level

100
Q

During inspiration, Palv drops to ___ H2O. What does this allow?

A

~-1cm H2O

enough to allow 500ml of air to be pulled into the lungs in ~2 seconds

101
Q

During expiration: Palv raises to __ H2O. What does this allow?

A

~1cm H2O

drives air out of alveoli in ~2-3 seconds

102
Q

What is intrapleural cavity pressure in relation to Patm? Why is it negative?

A

-4mmHg

You have 2 forces trying to pull lungs away from thorax wall which would cause the lung to collapse.

  1. Lungs natural recoil tendency
  2. Surface tension of alveolar fluid

Opposed by elasticity of chest wall and maintaining pleural fluid adhesive force.

103
Q

What is transpulmonry pressure and why is it important?

A

Palv - Pip = difference between alveolar pressure and pleural pressure.

Fxn: to keep air spaces of lungs open.

104
Q

What is atelectasis?

A

lung collapse or part (alveoli)

105
Q

What is pneumothroax?

A

air in intrapleural space.

106
Q

What is lung compmliance and what determines it?

A

measure of change in lung volume that happens with a given change in transpulmonary pressure.

Determined by:

  1. distensibility - elastic forces of lung tissue
  2. Alveolar Surface Tension - surfactant (decreases)
107
Q

What is the Bohr effect?

A

Weakening of Hgb-O2 bond

O2 unloaded where it’s most needed.

108
Q

What is surfactant made up of and what function does it serve?

A

Produced by Type II cells, made of phospholipids, proteins, and ions.

Reduces surface tension which reduces effort required by respiratory muscles to expand lungs.

109
Q

What affect does interstitial lung disease have on distensibility?

A

reduces it

110
Q

Does an alvoli collapse due to increase or decrease in distensibility.

A

decreased distensibility

111
Q

What is TV? About how many ml is it?

A

Tidal Volume - Amount of air inhaled/exhaled w/ breathing under resting conditions. ~500ml

112
Q

What is IRV?

A

Inspiratory Reserve Volume - Amount of air that can be forcefully inhaled after normal TV exhalation

113
Q

What is ERV?

A

Expiratory Reserve Volume - Amount of air that can be forefully exhaled after normal tidal volume exhalation.

114
Q

What is RV?

A

Residual Volume - Amount of air remaining in lungs after forced exhalation.

115
Q

What is TLC?

A

Total Lung Capacity - Max amount of air contained in the lungs after max inspiritory effort.

TLC = TV + IRV + ERV + RV

116
Q

What is VC?

A

Vital Capacity - max amount of air that can be expired after max inspiritory effort.

VC = TV + IRV + ERV

117
Q

What is IC?

A

Inspiratory Capacity - max amount of air that can be inspired after normal expiration.

IC = TV + IRV

118
Q

What is FRC?

A

Functional Residual Capacity - Volume of air remaining in the lungs after normal TV expiration.

119
Q

What is FVC?

A

Forced Vital Capaity - Max vol of air exhaled during forced maneuver.

120
Q

What is FEV1?

A

Forced expired volume in 1 second. Measure of how quickly lungs emptied.

121
Q

Which diffuses faster, CO2 or O2? Why?

A

CO2

  • More soluable (20% more b/c of molecular attraction to water)
  • Less pressure difference needed to cause CO2 diffusion than O2 diffusion

–remember at same partial pressure, CO2 diffuses almost 20x faster.

122
Q

How do you calculate VA?

A

VA = Frequency * (VT - VD)

123
Q

What makes up the respiratory membrane?

A

Alevolar + Capillary Walls + Fused Basement Membrane

124
Q

Roughly what volume of blood is in the lungs?

A

~450ml

125
Q

Roughly what volume of blood is in the pulmonary capillaries?

A

70ml

126
Q

Which alveoli get the blood?

A

The ones with the best oxygenation.

127
Q

What affect does low oxygen concentration have on capillaries? Why?

A

constriction

(opposite to systemic capillary reaction to low O2)

Purpose is to make sure blood goes to alvoli with high O2

128
Q

What happens if Palv > Ppc?

A

capillaries close and no blood flow

129
Q

With exercise, what happens blood volume to the lung? Capillaries?

A

Blood volume increased 4-7 fold.
Increase # of open capillaries and they distend and therefore increase rate of low.

Pulmonary pressure increases but minimally.

130
Q

How do you calculate the partial pressure of a specific gas?

Ex.
O2 = 20.84%

A

Partial Pressure = Atmospheric Pressure * percentage of molecule in gas

PO2 = 760mmHg * 20.84% = 159mmHg

131
Q

The rate of diffusion of a gas is directly related to its

A

partial pressure

132
Q

What is pressure of a gas in fluid determined by?

A

Concentration ad Solubility coefficient of gas

133
Q

Does O2 or CO2 have a higher Solubility coefficient? Why? What does the mean?

A

O2 = 0.024
CO2 = 0.57
High # = more Soluble

CO2 in 20% more solube in liquids than O2 is. Different b/c molecular attraction to water.

134
Q

Net rate of diffusion of a dissolved gas it determinant on

A
  1. Pressure difference
  2. Solubility of gas in fluid
  3. Cross Sectional Area of fluid
  4. Distance gas must diffuse
  5. Molecular weight of gas (lighter = faster)
  6. Temperature of fluid (constant in this case)
135
Q

What does the diffusion coefficient tell us? How does O2 compare to CO2?

A

Relative rate of gasses @ same partial pressure will diffuse

O2: 1
CO2: 20.3
CO: 0.81
N: 0.53
He: 0.95
136
Q

What is the limiting factor in the rate at which a respiratory gas can diffuse through a tissue? What does this mean in terms of the rate of diffusion?

A

Respiratory gases are soluble in lipids making diffusion across membranes easy. Rate of diffusion through tissue water is the limiting factor.

Therefore rate of diffusion through tissues ~= rate of diffusion through water.

137
Q

What two things control alveolar O2 concentration?

A

O2 constantly being absorbed from alveoli:

  1. Rate of absoprtion by pulmonary capillaries
  2. Rate of O2 entry into alveoli via ventilation
138
Q

T/F PO2 in alveoli can never exceed 149mmHg @ seal level if person is breathing normal ATM air.

A

True: Can’t go any higher than humidified air concentration.

139
Q

What happens if Palv > Patm?

A

lungs collapse.

140
Q

How much of alveolar air is replaced by new air each breath?

A

1/7

141
Q

What is the PO2 and PCO2 for:

Atmospheric Air / Inhaled Air

A 
PO2 = 160
PCO2 = 0.3
142
Q

What is the PO2 and PCO2 for: Humidified Air?

A 
PO2 = 150
PCO2 = 0.3
143
Q

What is the PO2 and PCO2 for: Alveolar Air?

A 
PO2 = 104
PCO2 = 40
144
Q

What is the PO2 and PCO2 for: Blood leaving alveolar capillaries?

A 
PO2 = 104
PCO2 = 40
145
Q

What is the PO2 and PCO2 for: Blood entering tissue capillaries?

A 
PO2 = 104
PCO2 = 40
146
Q

What is PO2 and PCO2 for:

INSIDE the tissues

A

PO2 = 45

147
Q

What is PO2 and PCO2 for:

Blood leaving tissue capillaries?

A 
PO2 = 40
PCO2 = 45
148
Q

What is PO2 and PCO2 for:

Blood entering alveolar capillaries?

A 
PO2 = 40
PCO2 = 45
149
Q

What is PO2 and PCO2 for:

Alveoli of lungs?

A 
PO2 = 104
PCO2 = 40
150
Q

What is the PO2 and PCO2 for:

Exhaled air?

A 
PO2 = 120
PCO2 = 27
151
Q

Does diffusion happen slowly or fast through the respiratory membrane?

A

Fast

  • Large surface area w/ small amount of blood spread throughout.
  • Small diameter of pulmonary capillaries w/ large blood cell.
152
Q

Diffusion of a gas across the respiritory membrane is affected by:

A
  1. Thickness of membrane
  2. Surface area of membrane
  3. Diffusion coefficient of gas
  4. Pressure different across the membrane
153
Q

How is the respiritory membrane diffusion capacity defined?

A

by the volume of gas that will diffuse through the membrane each minute, for a partial pressure difference of 1mmHg.

154
Q

What is Va/Q?
What is Optimal?
What is 0?
What is Infinity?

A

Ventiliation-perfusion ratio

  • 4 parts air / 5 parts blood = 0.8
  • 0 / 5 blood = 0: not breathing and no gas exchange
  • 4 air / 0 blood = infinity: adequate breathing but no blood flow and no gas exchange
155
Q

Where in the length of a capillary does pulmonary diffusion occur at rest?

A

First 1/3 of capillary length

156
Q

What is the PO2 at:

  • ISF surrounding Tissue
  • Tissue
  • Bronchial Arteries
A

ISF Surrounding Tissue = 40mmHg

157
Q

How much O2 do cells require to fully support chemical processes needed? What does this mean for us?

A

Cells require 1-3mmHg to fully support chemical processes needed.

Means there’s a reserve that you don’t actually need, good for exercise.

158
Q

HgB transports what percentage of O2 from lungs to tissues? How much additional O2 transport does this allow?
How is the rest carried?

A

97% - allows transport of 30-100x amount of O2 than if O2 was just transported in dissolved gas in water of blood.

3% is carried in H2O of plasma and RBCs

159
Q

What effect does High PO2 have on binding of O2 to HgB? How many ml of O2 are carries to the tissue with what Hgb saturation?
Low PO2?

A

PO2 High –> O2 binds w/ Hgb

  • Lungs/arterial blood = PO2 Hgb: 97%
  • 19.4ml O2 carries to tissue

PO2 Low –> O2 released from Hgb

  • Tissues = PO2 Hgb: 75%
  • Leaves w/ 14.4ml O2
160
Q

How many ml of O2 is left at the tissue for 100ml of blood?

A

5ml

161
Q

15 grams of Hgb can carry how many ml of O2 in 100ml of blood?

A

20ml (if 100% saturated)

162
Q

If Interstitial PO2 drops from 40mmHg to 15mmHg, what happens to O2 delivery?

A

Net delivery needs to be 15mmHg so there will be ~5ml O2 left in 100ml of blood.

3x normal amount of O2 delivered.

163
Q

What affect can an increase of CO by 6-7x normal have on O2 tissue delivery to tissues?

A

3x normal amount of O2 delivered from HgB + 6-7x normal CO = 20 fold increase of O2 delivery to tissues.

164
Q

Normal O2 delivery requires PO2 to drop to what?

A

40mmHg.

Hgb released enough O2 at a PO2 of 40mmHg for normal 5ml of O2 to be delivered and sets upper limit on O2 partial pressure.

165
Q

With exercise, what can PO2 in tissue drop to? Is this large or small?

A

40-15mmHg which is relatively small.

–> very large additional release of O2 from HgB

166
Q

What causes a right shift in O2-HgB dissociation curve?

A 
Increase in
Acid (decrease pH)
CO2
Exercise
2,3-BPG
Altitude
Temperature
167
Q

What causes a left shift in O2-HgB dissociation curve?

A 
Decrease in 
Acid (increase pH)
CO2
Exercise
2,3-BPG
Altitude
Temperature
168
Q

What is the Bohr effect?

A

Weakening of Hgb-O2 bond

O2 unloaded where it’s most needed.

169
Q

What is the limiting factor for cellular reactions?

A

ADP - not that you run out of O2

PO2 > 1mmHg is good

170
Q

How does diffusion limit cellular reactions?

A

Doesn’t cause major effects, need a pathology to really see problem

171
Q

How does blood flow limit cellular reactions?

A

If cut off then won’t deliver O2 to cells and they will die.

172
Q

How is Carbon Monoxide a problem with respiration?

A

CO combineds with HgB in same location as O2 but has a greater binding affinity than O2 so it will always win.

173
Q

What Pco allows CO to compete w/ O2 in combining w/ HgB?

What Pco is lethal?

A

.44mmHg CO
Allows 1/2 HbB to bind w/ CO

Pco .6mmHg

174
Q

Will a patient with CO poisoning look cyanotic?

A

No, don’t show signs or symptoms of O2 loss.

175
Q

What reaction can displace CO with O2 on Hgb?

A

Hyperbaric Rx

176
Q

What are the three forms of CO2 transport?

A

HCO3 (bicarbonate), HbCO2, Dissolved

177
Q

How many ml of CO2 per 100ml of blood is transported from tissues to lungs?

A

4ml CO2

178
Q

What percentage of CO2 is transported as bicarbonate? HbCO2? Dissolved?

A 
HCO3 = 85-90%
HbCO2 = 5%
Dissolved = 5-7%
179
Q

What is the chemical reaction for bicarbonate formation?

A

CO2 + H2O –> H2CO3 –> H+ HCO3

180
Q

Normall, how many ml of CO2 per 100ml of blood?

A

50 volumes percent = 50ml CO2 per 100ml Blood

4ml is exchanged during normal blood transport

181
Q

How does CO2 affect ph?

A

CO2 picked up in the tissue capillaries can decrease arterial blood pH

7.41 -> 7.37

w/release of CO2 in lungs –> pH returns to normal

182
Q

Which diffuses faster, CO2 or O2? Why?

A

CO2

  • More soluable (20% more b/c of molecular attraction to water)
  • Less pressure difference needed to cause CO2 diffusion than O2 diffusion

–remember at same partial pressure, CO2 diffuses almost 20x faster.

183
Q

If there is a decrease in blood flow at tissue interstitial fluid, what is the result on PCO2 in fluid?
Increase in Blood Flow? Increase in Metabolism?

A

PCO2 in fluid

> BF @ tissue ISF → metabolism → > ISF PCO2 @ all BF levels

184
Q

What is Respiratory Quotient equation?

A

RQ = CO2 Produced / O2 Consumed

185
Q

What is the Respiratory Quotient a ratio of? How does it differ? What does it approximate?

A
  • Ratio of metabolic gas exchange.
  • Differs depending on type of substrate metabolized: Carbs, Fats, Proteins
  • Approximates nutrient mixture catabolized for energy during rest and exercise
186
Q

What does Respiratory Exchange Ratio compare?
R > 1 means?
R

A

CO2 output to O2 intake

R > 1 means?

  • Hyperventilation
  • Exhaustive Exercise
  • Lipogenesis

R

187
Q

Eupnea:
Apneustic Breathing:
Apnea:
Hyperpnea:

A

Eupnea: normal respiratory rate and rhythm
Apneustic Breathing: prolonged inspirations
Apnea: cessation of breathing
Hyperpnea: increase in ventilation

188
Q

What are the 3 primary groups of neurons in the brainstem respiratory center?

A

Dorsal Respiratory Group
Ventral Respiratory Group
Pnemotaxic Center (pontine respiratory group)

189
Q

DRG
Location:
Main Function:
Sensory Info From:

A

DRG
Location: Medulla

Main Function: Main controller of inspiration: sets basic respiration rhythm

Sensory Info from: CN9+10 - peripheral chemoreceptors, baroreceptors, lung receptors.

190
Q

How does signal from DRG work to regulate breathing? Where do they travel?

A

APs from DRG ramp up and signal inspiritory muscles, diaphragm, to contract.

travel along reticulospinal tracts in SC –> phrenic n. and intercostal n.

191
Q

What is the point of ramping up of DRG signal? Why does the signal suddenly stop?

A

Ramping up precents jagged breathing.

Signal stop for 3s to stop stimulating diaphragm contraction for recoil and exhalation.

192
Q

VRG
Location:
Main Function:

A

VRG
Location: Medulla

Main Function: OVERDRIVE, normally inactive during quiet breathing, however with ventilatory needs –>inhalation/exhalation: diaphragm + ABS

193
Q

PRG
Location:
Main Function:

A

PRG
Location: Pons

Main Function: INHIBITORY, adjusts breathing rate.

Signals DRG, determines off point of inspiration ramp -> limits inspiration

194
Q

Strong PRG Signal:

Weak PRG Signal:

A

Strong Signal: short lung filling time
-Limit ramp time -> shorter insp and exp time -> increased breathing rate.

Weak Signal: longer lung filling time

195
Q

In what two ways can control of inspiritory ramping occur in the DRG?

A
  1. Rate of increase of ramp signal - can occur quickly when needed for rapid breathing.
  2. End of ramping - provides limit to time of inspiration, usual method for controlling rate of respiration.
196
Q

What is the function of Hering-breuer reflex?

A

Stretch receptors in walls of bronchi and bronchioles signal DRG when overstretch to turn ramp off.

Increases respiritory rate similar to pneumotaxic center.

197
Q

Which gas molecules have a direct effect on respiration?

A

CO2 and H

198
Q

What role to Central Chemoreceptors have (chemosensitive area in medulla)?
What does it signal to adjust?

A

acute effect of increase CO2 and H concentration.
-Strongly affected by changes in blood concentrations but primarily H+ because crosses BBB.
Stimulates other parts of respiratory center.

199
Q

What is the Long-term control of excitation of CO2?

A

Effects of increased CO2 decrease over 1-2 days b/c of renal adjustment.

200
Q

Describe short and long terms effects of an increase in blood CO2. What does this mean for a patient with COPD?

A

Strong acute effect on controlling respiratory drive, BUT weak chronic after 1-2 days because of adaptation.

COPD, not always breathing hard due to adjustment.

201
Q

What role do Peripheral Chemoreceptors have? How do they compare to Central Chemoreceptors?

A

Not as powerful as direct effects on respiratory center, however 5x faster.

Might offer important role at onset of exercise.

202
Q

Does O2 have a direct or indirect effect on (central) respiratory center?

A

indirect.

203
Q

Why is O2 usually not the main driver of respiration?

A

O2-Hgb buffer system ensures enough O2 delivery through wide range of PO2.

204
Q

What mechaism is there to assure O2 delivery when blood O2 falls too low?

A

Peripheral Chemoreceptors System (glossopharngeal carotid bodies and vagus aortic bodies) primarily respond to cchanges in blood O2 and transmit nervous signals to DRG.

Will have a rapid response if PO2 falls between 30-60mmg.

205
Q

If CO2 and H+ are kept constant, and PO2 drops from 140 slowly to 60mmHg what will we see?

A

Not much until hits 60mmHg and ventilation will double.

206
Q

What happens to your CO2 and O2 response as you adapt to high altitude?

A
  • Respiratory center in brainstem loses ~4/5 of sensitivity to changes in PCO2 and H+ over 2-3 days.
  • Excess ventilation reduces CO2 so system to increase respiration fails.
  • Low O2 can drive system now.
207
Q

What can the brain do at the onset of exercise to affect ventilation?

A

Brain - may initially stimulate respiratory center in brainstem when sending motor impulses to the working muscles = “anticipatory stimulation”

CO2 will then take over.

208
Q

What are the 6 other factors that can influence ventilation?

A
  1. Pain: hypothalamic control - stimulation of respiratory center
  2. Pulmonary irritant receptors: Trachea, bronchi, bronchioles, lung receptors
  3. Proprioceptors: motion of limbs
  4. Brain edema
  5. Anesthsia
  6. ANP - Atrial Naturetic Peptide
209
Q

What are the effects of Hyperventilation on CO2?

Treatment?

A

Increase in rate and depth of breathing - exceeds need to remove CO2.

Low blood CO2 = hypocapnia -> cerebral vasoconstriction -> diziness

Treatment: bring CO2 back in brown bag.

210
Q

What are the effects of CO2 on a patient with emphysema?

A

Retention of CO2 occurs and levels are chronically elevated so chemoreceptors adapt.

Decrease PO2 acts on peripheral chemoreceptors and provides main stimulus for respiration = hypoxic drive

If give pure O2, body doesn’t recognize need to increase ventilation and stop breathing.

211
Q 
How is Obstructive Pulmonary Disease defined?
Total Lung Capacity?
Reserve Volume?
Forced Vital Capacity?
FEV1?
FEV1/FVC?
A
  • Air gets trapped in lungs = impacted flow
  • Obstruction of airflow –> air trapped in lungs.
TLC slightly increases
RV increases
FVC same or greater
FEV1 decreases
FEV1/FVC decreases
212
Q 
How is Restrictive pulmonary disease defined?
Total Lung Capacity?
Forced Vital Capacity?
FEV1?
FEV1/FVC?
A

-Volume impacted, restricted lung expansion –> decrease lung volumes.

TLC decreases
FVC decreased
FEV1 decreases slightly
FEV1/FVC increases

213
Q

What are the nonseptic forms of COPD?

A

Chronic bronchitis, emphysema, asthma, bronchiectasis

214
Q

What are the septic forms of COPD?

A

Cystic Fibrosis, bronchiectasis.

215
Q

What restrictive lung diseases?

A

Interstitial Lung Disease, Idiopathic Pulmonary Fibrosis (IPF)

216
Q

What are characteristics of Emphysema?

A
  • chronic =copd
  • Less surface area in alveoli
  • Obstructive Disease - able to get air in but hard time getting it out
  • Often from smoking
  • Abnormal/permanent enlargement of air spaces distal to terminal bronchioles + destruction of alveolar wall
  • Airflow limitation b/c loss of elastic recoil.
217
Q

COPD main characteristics.

A
  • Not fully reversible and progressive.

- Associated w/ abnormal inflammatory response of lungs to inhaled noxious particles gasses.

DPT732: MAP II (14 decks)

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