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nbde biochem > page370-379 > Flashcards

page370-379 Flashcards

1
Q

Total lung volume (TLV) =

A

IRV + TV + ERV + RV.

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2
Q

https://drive.google.com/open?id=0B8uJUY-tie8GYVhRc1B1SHJfbDg

A

https://drive.google.com/open?id=0B8uJUY-tie8GR2VhemZ0RDE0RjA

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3
Q

https://drive.google.com/open?id=0B8uJUY-tie8GanZlLVN4NlB0Szg

A

https://drive.google.com/open?id=0B8uJUY-tie8GMEhmX3ZQSzFpOW8

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4
Q

Active process of inspiration

A

■ Requires muscular effort.

■ Mostly diaphragm at rest.

■ Intercostals used on exertion (accessory muscles).

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5
Q

Inspiratory effort causes:

A

■ ↓ intrapleural pressure.

■ ↓ alveolar pressure.

■ Pressure gradient from mouth to alveoli.

■ Gas flow down pressure gradient.

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6
Q

Expiration

A

■ Passive process (usually).

■ Due to lung recoil.

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7
Q

Relaxation of inspiratory muscles causes:

A

■ ↑ intrapleural pressure (intrapleural pressure becomes less negative).

■ ↑ alveolar pressure.

■ Pressure gradient from alveoli to mouth.

■ Gas flow down pressure gradient

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8
Q

FUNCTIONAL RESIDUAL CAPACITY

A

■ FRC = At rest.

■ Balance between inspiratory and expiratory forces.

■ Collapsing forces = Expanding forces.

■ Muscle contraction is needed to ↑ or ↓ lung volume from FRC.

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9
Q

https://drive.google.com/open?id=0B8uJUY-tie8GS1RPOG1sUmt0LWM

A

https://drive.google.com/open?id=0B8uJUY-tie8GV3RCcVlDekdXckE

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10
Q

ALVEOLAR PRESSURE

A

■ Atmospheric pressure in resting position.

■ 760 mm Hg (at FRC). Palv = 0 mm Hg

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11
Q

INTRAPLEURAL PRESSURE

A

■ Pressure within pleural cavity between outer surface lung and inner surface

chest cavity.

■ 756 mm Hg (at FRC) (< atomospheric pressure). Ppl = −34 mm Hg

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12
Q

ALVEOLAR VENTILATION

A

■ Amount of gas that reaches the functional respiratory units (ie, alveoli) per

minute.

■ Amount of atmospheric air that can undergo gas exchange.

■ Good gauge for breathing effectiveness

VA=RR °ø (TV − dead space air volume).

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13
Q

RESPIRATORY RATE

A

■ Breaths per minute.

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14
Q

TIDAL VOLUME

A

■ TV = amount of air brought into/out of lungs with a normal breath.

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15
Q

■ 500 mL.

■ 350 mL used for alveolar ventilation.

■ 150 mL dead space (fixed due to conducting airways).

A

tidal vol

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16
Q

DEAD SPACE

A

■ VD = Volume of air not participating in gas exchange

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17
Q

Anatomic dead space.

A

■ Typically 150 mL.

■ Volume of nonventilated gas in airways.

■ No gas exchange occurs within the nasal passages, pharynx, trachea,

bronchi.

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18
Q

Physiologic dead space.

A

■ Due to alveoli that are ventilated but not perfused.

■ Usually insignificant, unless there is disease.

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19
Q

TV °* RR = .

A

VT

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20
Q

https://drive.google.com/open?id=0B8uJUY-tie8GTnV4NlJJdHExLUk

A

https://drive.google.com/open?id=0B8uJUY-tie8GZm5NRzFIY0Z2RUk

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21
Q

Conducting zone airways contain mucous-secreting cells:

A

■ Goblet cells

■ Mucous cells

■ The epithelium is pseudostratified ciliated columnar.

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22
Q

Respiratory zone, alveolar wall has:

A

■ Type I epithelial cells

■ Type II epithelial cells ↓ pneumocytes

■ Produce surfactant

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23
Q

O2 uptake, CO2 elimination by the blood

A

■ O2 diffusion (alveolus → blood)

■ CO2 diffusion (alveolus ← blood)

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24
Q

Partial pressure gradient

■xxx difference between two sides of the membrane.

■ Diffusion occurs from high to low pressure (down the gradient).

■ PAyyy > Pzzz (alveolar > pulmonary arterial); O2 diffuses from

alveoli →aaaa

■ PaCO2 xxxx > PACO2 in xxxx; CO2 diffuses from blood →alveoli

A

Partial pressure gradient

■ Pressure difference between two sides of the membrane.

■ Diffusion occurs from high to low pressure (down the gradient).

■ PACO2 > PaO2 (alveolar > pulmonary arterial); O2 diffuses from

alveoli → blood.

■ PaCO2 blood > PACO2 in alveolus; CO2 diffuses from blood →alveoli

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25
Q

Gas solubility

■ Number of molecules dissolved in the liquid aa partial pressure of gas bb.

■ Solubility is an xxx property of the gas.

■ Solubility xx as partial pressure yy (Henry’s law). CO2 more zzz

than O2.

A

Gas solubility

■ Number of molecules dissolved in the liquid ↑ partial pressure of gas ↑.

■ Solubility is an intrinsic property of the gas.

■ Solubility ↑ as partial pressure ↑ (Henry’s law). CO2 more soluble

than O2.

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26
Q

Thickness of membrane (alveolus)

■ Rate of diffusion is xxxl to the diffusion distance.

■yy diffusion as zz alveolar thickness

A

Thickness of membrane (alveolus)

■ Rate of diffusion is inversely proportional to the diffusion distance.

■ ↑ diffusion as ↓ alveolar thickness

27
Q

Alveolar surface area

■ Rate of diffusion is xxxx to surface area.

■ x surface area (eg, emphysema), y diffusion, z gas exchange

A

Alveolar surface area

■ Rate of diffusion is directly proportional to surface area.

■ ↓ surface area (eg, emphysema), ↓ diffusion, ↓ gas exchange

28
Q

Hemoglobin

A

Carries O2 from lungs to tissues.

■ Carries CO2 from tissues to lungs.

29
Q

Normally:

■xx saturated with O2 in lungs (arterial).

■ yy saturated in tissues (venous).

■ PaO2 = 40 mm Hg

■ zz million Hb molecules in each erythrocyte.

■ Synthesis begins in xxxx

A

hemoglbin

30
Q
A

https://drive.google.com/open?id=0B8uJUY-tie8GVlAtM3NCSFB4bnc

31
Q

https://drive.google.com/open?id=0B8uJUY-tie8GbWJ0Z0JSbHlCb1U

A

https://drive.google.com/open?id=0B8uJUY-tie8GZkVfUmxUdG5Gb1E

32
Q

Bohr Effect

A

Curve shifts right (→) in an acidic environment (↓pH) to help unload O2 to

the tissues.

■ Hb has decreased affinity for O2 when pH ↓.

■ H+’s ↑ as pH ↓.

■ The H+’s bond more actively to deoxygenated Hb than to oxyhemoglobin.

■ As CO2 ↑, pH ↓, curve shifts to the right (→).

33
Q

Haldane Effect

A

■ Oxygen tension affects the affinity of Hb for CO2.

■ High oxygen tension—lungs:

■ Hb ↑ O2 binding; ↓ affinity for CO2.

■ CO2 released in the lungs (as ↑ O2–Hb).

34
Q

Low oxygen tension—tissues:

A

■ Hb ↓ O2 binding; ↑ affinity for CO2 (binds H+, forms carbamino compounds).

■ CO2 uptake in the tissues (as ↓ O2–Hb).

35
Q

Amount of O2 in Blood

A

■ Dissolved O2 + O2 bound to Hb.

36
Q

https://drive.google.com/open?id=0B8uJUY-tie8GR083VnM2cFhaN1k

A

https://drive.google.com/open?id=0B8uJUY-tie8GNFFHR1RYTkVNWjg

37
Q

OXYGEN CONTENT

A

■ Total amount of oxygen carried in blood (PO2 + O2–Hb).

■ Determined mostly by the amount of hemoglobin and its saturation.

■ Amount of hemoglobin is affected by anemia (production, loss, or

destruction).

■ The more hemoglobin in blood, the more O2 that can be carried.

38
Q

OXYGEN SATURATION

A

■ The amount of Hb saturated with O2.

■ Corresponds to O2–Hb curve.

■ Determined by:

■ PO2 (important; see table corresponding SaO2 : PO2).

■ O2 affinity of Hb altered by:

39
Q

■ Changes in Hb molecule.

■ Intrinsic (hemoglobinopathies).

■ Extrinsic (eg, changes in pH, PCO2, temperature, etc.).

■ Competition for Hb binding (eg, CO poisoning).

A

O2 saturation determined by

40
Q

NORMAL VALUES

A

■ Oxygen content (per 1 g Hb) = 1.34 mL of O2.

■ Hemoglobin concentration = ~15 g/dL.

■ Women: 12–16 g/dL.

■ Women have ↓ Hb concentrations than men

■ Men: 14–18 g/dL.

■ Infants: 14–20 g/dL.

■ Oxygen concentration = ~20 g-mL/dL (or 15 g/dL °ø 1.34 mL)—just 20.1 mL.

41
Q

OXYGEN -CARRYING CAPACITY OF BLOOD

A

Depends on:

■ Oxygenation (from lungs).

■ FiO2.

■ PaO2 (gradient).

■ Effective gas exchange (no dead space or shunt

42
Q

Hb concentration.

■ Hb avidity for oxygen.

■ CO.

■ Left shift of curve.

A

OXYGEN -CARRYING CAPACITY OF BLOOD

43
Q

Perfusion.

■ Cardiac function.

■ Patency of vessels.

■ Adequacy of forward flow

A

OXYGEN -CARRYING CAPACITY OF BLOOD

44
Q

Carbon Dioxide

See Figure 13–3.

■ Carbon dioxide (CO2) is carried in blood as:

A

■ Bicarbonate in serum (most).

■ Bicarbonate in RBC.

■ Carbaminohemoglobin.

■ CO2

+ NH2 group of Heme (not Fe2+ of Heme like O2 or CO).

■ Dissolved in blood (PCO2).

45
Q

CHLORIDE SHIFT

A

■ Bicarbonate carried in serum is generated within the RBC.

■ It is transported to the serum in exchange for Cl−.

46
Q

https://drive.google.com/open?id=0B8uJUY-tie8GSDBXblpPNDY3Mlk

A

https://drive.google.com/open?id=0B8uJUY-tie8GT3dJdGpNNVUwWFE

47
Q

https://drive.google.com/open?id=0B8uJUY-tie8GZ09FNDhtMkdudmc

A

https://drive.google.com/open?id=0B8uJUY-tie8GWWYwSEVBZ2lxNTQ

48
Q

Hypoxemia

A

■ Low oxygen level in blood (PO2 <80).

■ Causes of hypoxemia:

■ ↓ FiO2

■ Hypoventilation

■ V/Q mismatch

■ Shunt

■ Diffusion limitation

49
Q

HYPOXIC VASOCONSTRICTION

A

■ Mechanism to minimize V/Q mismatch.

50
Q

Shunt (air cannot get into alveolus).

A

■ Peanut occluding bronchiole (child).

■ Atelectasis.

51
Q

Blood perfuses past the alveolus.

A

Blood perfuses past the alveolus.

■ No/minimal gas exchange occurs.

■ Response is vasoconstriction of the pulmonary vasculature in that region.

■ ↓ amount of blood going to nonventilated segment of lung.

52
Q

If this vasoconstriction secondary to hypoxia exists for long enough,

A

If this vasoconstriction secondary to hypoxia exists for long enough,

■ Get permanent secondary changes to the pulmonary vasculature.

■ Pulmonary hypertension.

■ Only place in body to constrict, not dilate

53
Q

Hypercarbia

A

■ ↑ CO2 in blood.

■ Occurs because of either or both of the following:

■ ↑ CO2 production.

■ ↓ VA (alveolar ventilation)—hypoventilation.

■ Compensation: hyperventilation.

■ Headache.

■ Confusion.

■ Coma.

54
Q

Hyperventilation

■ ↑ rate and depth of breathing exceeding requirement for O2 delivery and

CO2 removal

A

■ Stimulated by:

■ ↓ PO2 in normal circumstances (non-COPD).

■ Chemoreceptor stimulation (↑CO2, ↑H+, ↓PO2).

■ Effect on brain—emotional situations, anxiety.

55
Q

Hyperventilation

Results in:

A

■ ↓ CO2: hypocapnia (hypocarbia).

■ Respiratory alkalosis (pH ↑).

■ ↑cerebrovascular resistance.

■ ↓ cerebral blood flow.

■ ↑PO2 (and arterial oxygen concentration

56
Q

https://drive.google.com/open?id=0B8uJUY-tie8GSi1UR3h0dDNLb1k

A

https://drive.google.com/open?id=0B8uJUY-tie8GLXZqUlFDNEFvSHM

57
Q

SYMPTOMS OF HYPERVENTILATION

A

■ Related to ↓ cerebral blood flow.

■ Example: anxiety → ↑ventilation → ↓ CO2 → ↓ cerebral blood flow →

neurologic symptoms:

■ Faintness/dizziness.

■ Blurred vision.

■ Also experience sensation of:

■ Suffocation.

■ Chest tightness.

58
Q

Terminate hyperventilation attack must:.

A

■ ↑ PCO2.

■ Breathing in and out of a plastic bag.

■ Inhale 5% CO2 mixture

59
Q

Respiratory Drive

A

■ Based on arterial PCO2, specifically H+.

■ The H+ (derived from CO2) that acts at central chemoreceptors (medulla).

60
Q

PATHWAY

A

■ As ↑ PCO2 → CO2 diffuses from cerebral blood vessels into CSF → carbonic

acid (H2CO3) is formed → dissociates into bicarbonate (HCO3

−)

and protons (H+s) → these protons (H+s) stimulate the central chemoreceptors→↑

ventilation.

■ CO2 can diffuse from the blood vessels into CSF across the BBB because

it is nonpolar.

61
Q

↑RESPIRATORY DRIVE

A

↑RESPIRATORY DRIVE

■ Central chemoreceptors (medulla)

■ ↑ PCO2 (as its byproduct, H+, in CSF or brain interstitial fluid sensed

in medulla).

■ Peripheral chemoreceptors (carotid or aortic bodies)

■ ↑ H+ (in blood or brain interstitial fluid).

■ ↓ PO2 (in blood)(<60 mm Hg

62
Q

FUNCTION OF RESPIRATORY REGULATION

A

■ Keep alveolar PCO2 stable (prevent hypercarbia or hypocarbia).

■ Buffer acid–base changes.

■ Prevent hypoxemia (↑ PO2 when it falls).

63
Q

https://drive.google.com/open?id=0B8uJUY-tie8GNHNHc1Rkay1qUnM

A

https://drive.google.com/open?id=0B8uJUY-tie8GVGRFbWRzaHZVOEE

64
Q

https://drive.google.com/open?id=0B8uJUY-tie8GTEF1V19TbVU4cjQ

A

https://drive.google.com/open?id=0B8uJUY-tie8GdnFUQjZSS05ueUE

nbde biochem (14 decks)

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