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The Respiratory System > Physiology > Flashcards

Physiology Flashcards

1
Q

What is external respiration?

A

Exchange of oxygen and carbon dioxide between body cells and the external environment

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2
Q

What is internal respiration?

A

The intracellular mechanisms that consume oxygen and produce carbon dioxide.

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3
Q

Which 4 body systems are involved in external respiration?

A
  1. Respiratory system 2. Cardiovascular system 3. Haematology system 4. Nervous system
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4
Q

In terms of respiration what does the term “ventilation” refer to?

A

The mechanical process of moving air between the alveoli and the atmosphere

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5
Q

What is Boyle’s Law?

A

At any constant temperature the pressure exerted by a gas varies inversely with the volume of the gas ( gas will move from area of high pressure to area of low pressure at constant temperature )

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6
Q

Using Boyle’s Law, describe why the lungs must expand to allow air to enter them during inhalation.

A

As the volume of the lungs (and thoracic cavity) increase, the pressure decreases. This means atmospheric pressure is high than intrathoracic pressure. Gas (air) flows down the pressure gradient into the lungs

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7
Q

Which two forces hold the thoracic walls and the lungs in close contact?

A
  1. The intrapleural fluid cohesiveness (fluid tension)
  2. The negative intrapleural pressure
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8
Q

A transmural pressure gradient exists between lung walls. What is this?

A

A difference in pressure between any separtation

The transmural pressure gradient refers to the difference in pressure between the inside of the airways and the outside of the lung tissue (pleural space).

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9
Q

What causes the increase in thoracic volume during inspiration? (2)

A
  1. Contraction of the diaphragm 2. External intercostal muscle contraction
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10
Q

During expiration, which two factors contribute to the recoil of the lungs?

A
  1. Elastic properties of the involved muscles 2. Alveolar surface tension
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11
Q

What sort of situation would result in a lung collapse?

A

Any situation involving pleural pressure equalising with or exceeding atmospheric pressure e.g. a puncturing wound

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12
Q

What is alveolar surface tension?

A

The attraction between water molecules at the liquid air interface of the alveoli - water molecules pull towards each other

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13
Q

What does alveolar surface tension allow for?

A

A resistance to lung stretching - the water molecules are attracted together so oppose stretching forces

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14
Q

What does the law of LaPlace state?

A

Smaller alveoli have a higher tendency to collapse due to the increased proximity of the water molecules

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15
Q

What is pulmonary surfactant and where is it produced?

A

Pulmonary surfactant is a complex mixture of lipids and proteins. It is produced by type II alveoli

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16
Q

What is the effect of pulmonary surfactant?

A

It reduces surface tension by “diluting” the effect the water molecules have by interspersing them ( one head attaches to water molecule the other pulls upward )

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17
Q

Why do some infants suffer from respiratory distress syndrome?

A

Foetal lungs cannot synthesise surfactant meaning premature babies do not have enough surfactant in their lungs. Breathing will them become strenuous as the babies must overcome the high surface tension (of the water droplets) to inflate the lungs

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18
Q

Describe alveolar interdependence

A

Alveolar interdependence describes the fact that adjacent alveoli protect each other from collapse. If one alveoli begins to collapse, others around it will compensate and stretch. As volume increases in the surrounding alveoli, pressure decreases meaning air flows to the collapsed alveoli to reinflate it. This is due to the pressure gradient.

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19
Q

What are the three types of muscles involved in respiration?

A
  1. Accessory muscles (scalenus, sternocleidomastoid) 2. Major muscles (diaphragm, external intercostal muscles) 3. Muscles of active expiration (abdominal muscles, internal intercostal muscles)
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20
Q

What is the tidal volume?

A

The volume of air entering or leaving the lungs in a normal breath (around 500ml)

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21
Q

What is the inspiratory reserve volume?

A

This is the extra volume of air that can be breathed in over and above the tidal volume (around 3000ml)

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22
Q

What is the inspiratory capacity?

A

The maximum volume of air that can be breathed in (inspiratory reserve volume + tidal volume)

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23
Q

What is the expiratory reserve volume?

A

This is the extra volume of air that can be breathed out over and above the tidal volume (around 1000ml)

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24
Q

What is the residual volume?

A

This is the minimum volume of air remaining in the lungs even after a maximal expiration - it is always present

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25
Q

What is functional residual capacity and how is it calculated?

A

Resting lung volume (Expiratory reserve volume + residual volume)

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26
Q

What is vital capacity and how is it calculated?

A

The maximum volume of air that can be expired in a single breath following maximum inspiration (inspiratory reserve volume + tidal volume + expiratory reserve volume)

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27
Q

What is total lung capacity and how is it calculated?

A

This is the total volume of air the lungs can hold (vital capacity + residual volume) Around 5.7 litres

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28
Q

Why is total lung capacity hard to measure in real life?

A

Residual volume must be known and this cannot be measured

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29
Q

What could lead residual volume to increase?

A

Reduction in elastic recoil of the lungs - as in emphysema

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30
Q

Which two measurements can be plotted on volume/time curve, and what are they?

A

Forced Vital Capacity (FVC) ; The volume a person can forcefully inspire and expire
o It is the highest point in the curve
Forced Expiratory Volume - FEV (1 sec)
o The volume of air that can be forcefully expired in the
first second

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31
Q

For normal healthy patients, FEV1/FVC x 100 should equal what?

A

80%

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32
Q

What does a low FEV1/FVC ratio indicate?

A

Obstructive lung disease

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33
Q

What type of results do individuals with restrictive lung disease give for a FEV1/FVC ratio test?

A

Normal, if not slightly elevated. They can instead be diagnosed by an initially low FVC

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34
Q

What is the primary determinant of airway resistance?

A

The radius of the conducting airway

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35
Q

How does the autonomic nervous system affect the resistance to airflow?

A

Sympathetic - decreases resistance (bronchodilation) Parasympathetic - increases resistance (bronchoconstriction)

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36
Q

Why are sufferers from obstructive lung conditions likely to suffer from collapsing airways?

A

he collapse of the airway in obstructive lung conditions can be caused by multiple factors, including the narrowing of the bronchi due to the loss of recoil, the loss of elastic recoil in the alveoli seen in emphysema, and the buildup of mucus in the airways, which can all contribute to increased resistance to airflow and decreased ventilation. As a result, this can cause a decrease in air pressure within the airways during exhalation, leading to the collapse of the airway walls and obstruction of airflow

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37
Q

How is peak flow rate measured?

A

Using a peak flow meter

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38
Q

Describe how to use a peak flow meter

A

A short sharp block is given into the meter The score on the scale at the side is taken 3 attempts are given to allow for poor initial technique The best value is recorded This test can highlight obstructive lung disease

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39
Q

What is pulmonary compliance?

A

This is a measure of the effort required to stretch or distend the lungs

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40
Q

What are the two methods to measure pulmonary compliance clinically?

A
  1. Static - the change in volume for any given pressure is measured (measures elastic resistance only)
  2. Dynamic - change in volume for any given pressure during the movement of air (measure both elastic resistance and airway resistance)
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41
Q

The less compliant the lungs are the _____ work must be done to inflate them

A

More

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42
Q

List 3 factors that decrease pulmonary compliance

A

This refers to the ability of the lungs to stretch and expand in response to changes in pressure. During increased work of breathing
Pulmonary fibrosis
Pulmonary oedema
Lung collapse due to Pneumonia or Absence of surfactant

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43
Q

How may a patient present clinically if they have less complaint lungs

A

low long compliance may indicate fibrosis however patients can still experience Breathless and Low exercise tolerance
becauses Lung fibrosis can make it more difficult for the lungs to expand and contract during breathing.

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44
Q

When would pulmonary compliance increase?

A

When elastic recoil is lost

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45
Q

Describe a condition in which pulmonary compliance is increased

A

Emphysema Hyperinflation (air trapping in the lungs) occurs causing increased difficulty during exhalation

Age also increases compliance

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46
Q

List 3 factors which will increased the required work done by the lungs

A
  • Decreased pulmonary compliance
  • Increased pulmonary compliance
  • Increased airway resistance (potentially when bronchoconstricted)
  • Decreased elastic recoil
  • Increased elastic recoil
  • Need for increased ventilation (low O2)
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47
Q

What is airway physiological “dead space”?

A

This is the area within the airway (anatomical) and alveoli that is unsuitable for diffusion to occur

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48
Q

How is alveolar ventilation calculated?

A

Dead space volume must be subtracted from the tidal volume

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49
Q

What is the difference between pulmonary and alveolar ventilation?

A

Pulmonary - volume of air breathed in and out per minute (includes dead space) Alveolar - volume of air exchanged between atmosphere and alveoli (excludes dead space)

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50
Q

How can pulmonary ventilation be increased?

A

Increasing depth and rate of breathing

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51
Q

Why is pulmonary ventilation increase advantageous?

A

Amount of inhaled air increases but dead space does not - this causes relative increases in alveolar ventilation

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52
Q

What is ventilation?

A

Rate at which gas passes through the lungs

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53
Q

What is perfusion?

A

Rate at which blood passes through the lungs

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54
Q

What is the ventilation perfusion match?

A

This ensures ventilation of gas can match the blood flow for optimised gas transfer - local controls can ensure this can happen

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55
Q

What will happen when perfusion is greater than ventilation?

A

CO2 build up in alveoli Airway resistance is reduced in these situations as well as contraction of arteriolar smooth muscle to reduce blood flow to match the airflow

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56
Q

What will happen when the ventilation is greater than perfusion?

A

Increased alveolar oxygen concentration Pulmonary vasodilation will occur to incease blood flow to match the ventilation Constriction of airways also increases resistance to reduce ventilation

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57
Q

Which four factors can influence alveolar gas exchange?

A
  1. Partial pressure gradient (of O2 and CO2) 2. Diffusion coefficient (of O2 and CO2) 3. Surface area of alveolar membrane 4. Thickness of alveolar membrane
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58
Q

What is Dalton’s law of partial pressure?

A

The total pressure of a gaseous mixture of a sum of all the partial pressure of individual gases

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59
Q

What is the partial pressure of a gas?

A

The pressure one gas would exert if it were the only gas making up the full volume

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60
Q

How is partial pressure of oxygen calculated?

A

PaO2 = PiO2 - [PaCO2/0.8] 0.8 = respiratory exchange ratio (ratio of CO2 produced/O2 consumed)

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61
Q

How is mmHg easily converted to KPa?

A

Divide by 7.5

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62
Q

Why is partial pressure for carbon dioxide much lower than oxygen?

A

CO2 is much more soluble than O2

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63
Q

What is the diffusion coefficient?

A

This is the solubility of a gas in a membrane

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64
Q

Why is there always a small pressure gradient between oxygen in the alveoli and the arteries?

A

Ventilation and perfusion matching is always slightly out of sync

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65
Q

What could be the cause of a large oxygen partial pressure difference in alveoli and arteries? (2)

A
  1. Significant gas exchange problems in the lungs 2. Left to right heart shunt
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66
Q

What is Fick’s law?

A

The amount of gas that moves across a sheet of tissue in unit time is proportional to the area of the sheet but inversely proportional to its thickness

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67
Q

What does Henry’s law state?

A

The amount of given gas dissolved in a given type and volume of liquid at a constant temperature is proportional to the partial pressure of the gas in equilibrium with the liquid

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68
Q

In which two forms is oxygen found in the blood?

A
  1. Bound to haemoglobin 2. Physically dissolved
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69
Q

What is the primary factor determining the percentage saturation of haemoglobin with oxygen?

A

Partial pressure of oxygen

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70
Q

Which factors can impair oxygen delivery to tissues?

A
  1. Decreased PiO2 2. Respiratory disease 3. Anaemia 4. Heart failure
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71
Q

What term is used to describe the increased affinity Hb has for O2 with each subsequent oxygen molecule bound?

A

Cooperativity (sigmoid curve is shown)

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72
Q

Why is the sigmoidal curve of oxygen cooperativity significant? (2)

A
  1. Moderate alveolar PO2 fall does not greatly impact O2 loading 2. Small drop in capillary PO2 means oxygen affinity is hugely decreased greatly reducing oxygen load
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73
Q

What is the Bohr effect?

A

O2 dissociation curve shifts to the right Factors reduce oxygen affinity and aid offload

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74
Q

Give examples of factors that will reduce oxygen affinity of haemoglobin

A
  1. Increase PCO2 2. Increase H+ 3. Increase temperature 4. Increase 2,3-biphosphoglycerate (allosteric haemoglobin inhibitor)
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75
Q

Why does foetal haemoglobin have increased affinity for oxygen?

A

Interacts less with 2,3-biphosphoglycerate O2 dissociation curve is shifted to left Allowing for O2 transfer from mother even in low PaO2

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76
Q

What is myoglobin?

A

Present in voluntary muscle and provides storage of oxygen Oxygen is released at low partial pressures Presence indicates muscle damage

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77
Q

What are the three ways carbon dioxide is transported in the blood?

A
  1. Solution (10%) 2. Bicarbonate (60%) 3. Carbamino compounds (30%)
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78
Q

How is bicarbonate formed in the blood?

A

CO2 + H2O ⇌ H2CO3 ⇌ H+ + HCO-3

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79
Q

In relation to the two reactions which produce bicarbonate, which catalyst acts on the first reaction?

A

Carbonic anhydrase

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80
Q

In the two equilibria used to form bicarbonate, why is it that they always run in the forward direction? (2)

A
  1. Haemoglobin buffers hydrogen ions and produces HbH 2. Chloride shift allows Cl- to enter the red blood cells as bicarbonate leaves into the plasma
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81
Q

How are carbamino compounds formed?

A

When CO2 combines with the terminal amine groups in blood proteins

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82
Q

How is HbCO2 formed? does it require enzymes

A

Haemoglobin is provided by the breakdown of oxyhaemoglobin into O2 and Hb.

Hb combines with CO2 forming HbCO2.

This process is rapid and does not require an enzyme

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83
Q

What is the Bohr effect? (2)

A

The Bohr effect states that the affinity of haemoglobin for oxygen decreases inversely with increasing acidity and carbon dioxide concentration. The oxygen-haemoglobin curve shifts to the right

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84
Q

For the oxygen-dissociation curve what are the axis labels?

A
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85
Q

Which factors would cause a right shift in the oxygen-haemoglobin curve?

A
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86
Q

Which factors would cause a left shift in the oxygen-haemoglobin curve?

A
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87
Q

Describe the Haldane effect

A

Removing O2 from Hb increases the ability of Hb to pick-up CO2 and CO2 generated H+

(and vice versa)

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88
Q

How does the presence of oxygen (at the lungs) affect the oxygen-haemoglobin curve?

A

It will shift it to the left causing increased CO2 (and H+) offload from haemoglobin

(Haldane effect)

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89
Q

How is oxygen released at a tissue cell?

A

Due to the Bohr effect

Increased CO2 and H+ reduces haemoglobin’s affinity for oxygen causing it to ofload

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90
Q

During gas exchnage at tissues, why is choliride shift important?

A

It ensures the equilibria for bicarbonate remain producing products in the forward direction.

By removind the end product (HCO3) and replace it for chloride ions, the reaction will continue to run in the forward direction

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91
Q

During gas exchnage at tissues, which haemoglin associated compound is broken down, and which two are synthesised?

A

Oxyhaemoglobin (HbO2) - broken down

HbH - synthesised

HbCO2 - synthesised

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92
Q

During gas exchange at the alveolus, which haemoglobin associated compounds are broken down and which one is resyntheised?

A

HbH - broken down - H+ released (used for HCO3- equilibria)

HbCO2 - CO2 released (diffuses into alveoli)

HbO2 - resynthesised (O2 diffuses from alveoli)

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93
Q

Carbon dioxide diffuses into the alveolus from whcih three sources?

A
  1. Plasma
  2. HbCO2 breakdown
  3. HCO3- equilibrium

(HCO3- + H+ (from HbH breakdown) → H2CO3 → H2O + CO2)

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94
Q

What controls the rhythm of respiration?

A

Medulla oblongata

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95
Q

What is the pre-Botzinger complex?

A

A complex of neurones responsible for the rhythm of breathing in the medulla

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96
Q

How does the pre-Botzinger complex function?

A
  1. Pre-Botzinger complex excites dorsal respiratory group neurones (inspiratory)
  2. Firing leads to contraction of inspiratory muscles → inspiration
  3. When firing stops → passive expiration
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97
Q

Active expiration involves increased firing rate of which neurones?

A

Usually dorsal which activate respiratory neurones subsqequently activating intercoastal, abdominal and other neurones.

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98
Q

What is the role of the pons?

A

The pins is an area of the medulla that modifies the produced rhythm of breathing

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99
Q

When dorsal respiratory neurones fire which area within the pons is inhabited ?

A

When dorsal respiratory neurons fire, the pneumotaxic center is inhibited, allowing for a prolonged inspiratory phase and deeper breathing.

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100
Q

What is the function of the pneumotaxic centre in the pons?

A

It will cause termination of inspiration

Without it apneustic breathing wil occur - a prolonged inspiration with insufficient short expiration

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101
Q

What is a function of the apneustic centre? (situation)

A

Influences breathing rhythm, by prolonging inspiration

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102
Q

What is the Hering-Breuer reflex?

A

A reflex which prevents over stretching of the lungs, due to the activation of stretch receptors.

Inspiration will be inhibited by activation of these receptors

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103
Q

What are joint receptors?

A

J receptors pick up impulses from moving muscles and adjust breathing according to intensity of movement

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104
Q

What is the function of the cough reflex?

A

To clear dust, dirt, excess mucous etc out of the respiratory tract

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105
Q

What does a cough relfex stimulate? (5)

A
  1. Short intake of breath
  2. Closure of larynx
  3. Contraction of abdominal muscles
  4. Opening of larynx
  5. Expulsion of air
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106
Q

What can chemoreceptors do in relation to the respiratory system?

A

Sense and control values of blood gas tensions

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107
Q

Where are chemoreceptors found in relation to the respiratory system? (2)

A
  1. The CNS (central) - at surface of medulla
  2. The rest of the body (peripheral)
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108
Q

What can peripheral chemoreceptors do?

A

Sense O2 and CO2 tensions as well as H+ concentration

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109
Q

What can central chemoreceptors detect?

A

Concentrations of H+ in cerebrospinal fluid

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110
Q

Of the three substances listed below, which are able to permeate the blood brain barrier?

  1. CO2
  2. H+
  3. HCO3-
A

Only CO2 is permeable

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111
Q

How are H+ and HCO3- produced in cerebrospinal fluid if they cannot pass the blood brain barrier?

A

CO2 dissociates across the BBB forming carbonic cid which can dissociate to form both H+ and HCO3-

(CO2 + H2O ⇔ H2CO3 ⇔ H<span>+​</span> + HCO3-)

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112
Q

What effect on ventilation do central chemoreceptors have?

A

By sensing high H+ concentrations in cerebrospinal fluid, they can increase ventilation

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113
Q

What is hypercapnia?

A

When there is excess CO2 in the blood

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114
Q

What is hypoxia?

A

When abnormally low amounts of O2 is present in tissues

115
Q

What is the effect of decreasing partial pressure of oxygen on ventilation?

A

It will increase rapidly up until a point where neural action becomes depressed (due to low oxygen) and ventilation then rapidly decreases

116
Q

What happens at high altitudes?

A

Partial pressure of oxygen is very low

Hyperventilation and increased cardiac output will occur to attempt prevention of hypoxia.

117
Q

What is the H+ drive of respiration?

A

Increased H+(mediated by peripheral chemoreceptors) in the blood (along with increased PaCO2) causes increased ventilation

As CO2 produces H+ and is eliminated, H+ load is decreased.

118
Q

The transthoracic pressure is equal to ninja nerd

A

Pip - Patm

119
Q

What does affect the negativity of intrapleural pressure? ninja

A

 Elasticity of the lungs

 Surface tension

 Elasticity of the chest wall

 (Gravity)

120
Q

The Surface tension increases thoracic cavity volume True / False ninja nerd

A

Tends to collapse the alveoli → tends to collapse the lungs → ↑Thoracic cavity volume

121
Q

some of the features of pleural fluid ninja nerd

A

a. located within the pleural cavity
b. it prevents inflammation
c. it allows the parietal and the visceral pleura to be tightly adherent to one another

122
Q

At rest the transpulmonary pressure is equal to ninja nerd

A

+4

this mean that visceral pleura is trying to expand (inflate) outward at rest

123
Q

At rest the pulmonary pressure is equal to ninja nerd

A

The atmospheric pressure

124
Q

some of the features of the e diaphragm ninja nerd

A

a. It is an inspiratory muscle
b. It’s innervated by the phrenic nerve
c. It depresses when it contracts

125
Q

what happen when the external intercostals contract ninja nerd

A

pull up the ribs

push the sternum outwards and upwards

the aim is to increase the thoracic cavity increasing the pressure

126
Q

During the inspiration process the Pip is -4 mmHg TRUE /FlASE ninja nerd

A

False this because Intrapleural pressure (Pip) need to get lower to increase the thoracic space thus plureal cavity get longer for more air to come in .

126
Q

During the inspiration process the Pip is -4 mmHg TRUE /FlASE ninja nerd

A

False this because Intrapleural pressure (Pip) need to get lower to increase the thoracic space thus plureal cavity get longer for more air to come in .

127
Q

During the inspiration process the TP is ninja nerd

A

+5mmHg

128
Q

what happen during inspiration? ninja nerd

A
  1. ↑Thoracic cavity volume
  2. ↑Transpulmonary pressure (TP)
  3. ↓Intrapulmonary pressure (Ppul)
  4. ↓Intrapleural pressure (Pip)
129
Q

During forced inspiration the intrapleural pressure is equal to ninja nerd

A

-4mmH

130
Q

During forced expiration the pulmonary pressure is equal to ninja nerd

A

+1mmHg

131
Q

During quiet expiration the transrespiratory pressure is equal to ninja nerd

A

2mmHg

132
Q

Which muscles involved in forced expiration? ninja nerd

A

abdominal

walls Transverse abdominus

Rectus abdominus

Internal oblique

External oblique

Internal intercostals

133
Q

Stretch receptors send inhibitory signals to the VRG in the medulla. true / false ninja nerd

A

true

134
Q

Internal intercostals increase thoracic cavity volume.

a. True
b. False ninja nerd

A

b. False

135
Q

Quiet expiration depends upon the elasticity of the
lungs.
a. True
b. False ninja

A

True

136
Q

Stimulations of the parasympathetic postganglionic fibers inverting bronchial and bronchiolar smooth muscle true false ninja nerd

A

True

137
Q

Some of the features of alveolar pressure ninja nerd

A

Alveolar pressure is greater than atmospheric pressure during force expiration Alveolar pressure is equal to the supination of intrapleural pressure plus electric recoil pressure Alveolar pressure I’d equal atmospheric pressure at the end of normal tidal expiration

138
Q

some of small airways features ? ninja nerd

A

a. The total resistance to airflow increases with
successive generations of airways because there are increasing numbers of units arranged in parallel.
b. The linear velocity of airflow decreases as the airways
increases in size because their total cross-sectional
area increases.
c. Alveolar elastic recoil plays an important role in
determining the resistance to airflow in small airways
because alveolar septal traction helps to increase
dynamic compression.

139
Q

describe the mechanism of
flow affection? ninja NERD

A

Pressure is directly proportional to gas flow with
consideration the resistance remains constant

140
Q

Which part of the airways has greatest airway
resistance? ninja nerd

A

a. Larger airways

141
Q

WHAT ARE following factors can greatly
influence airway resistance? NINJA NERD

A

a. Radius
b. Length
c. The lung volume

142
Q

The bronchioles smooth muscle is responsible for
contraction and relaxation of bronchi True / False ninja nerd

A

true

143
Q

Surface tension is caused by ninja nerd

A

Cohesive intermolecular interaction between water molecules

144
Q

Which structures that produces surfactant? ninja nerd

A

Type II alveolar epithelial cells

145
Q

What happens if we increase the radius of the alveoli
according to LaPlace’s law of sphere? ninja nerd

A

Decreased collapsing pressure of the alveoli

146
Q

What cause decrease in
alveoli radius? ninja nerd

A

Occlusion of the airway due to mucus

147
Q

Pores of Kohn ninja nerd

A

the structure that connects two alveoli for gas
flow?

148
Q

Which structure of the surfactant that binds to water
molecules? ninja nerd

A

Phosphatidylcholine group

149
Q

What is the function of SP-A and SP-D in surfactant? ninja nerd

A

Opsonization

150
Q

8) How does type II alveolar cells store surfactant? ninja nerd

A

Packs them inside of lamellar bodies

151
Q

What’s the correlation between surfactant distribution
and radius of alveoli?
ninja nerd

A

a. ↓ radius → surfactant distribution is denser

152
Q

A prematurely born baby (29th week of gestation) with
unremarkable medical and family history was reported to
have difficulty of breathing that causes cyanosis. The baby
is immediately put into ventilator and treated in ICU. No
signs of bacteremia from blood culture result.
Abnormalities found in CXR including diffuse opacities of
the lung. No cardiomegaly was found. What is the probable
cause and diagnosis for this case? ninja nerd

A

Cause: Not enough surfactant production in baby due to
prematurely born
Diagnosis: Infant respiratory distress syndrome

153
Q

Some of states decrease lung
compliance? ninja nerd 4

A

a. Lung fibrosis
b. Increased pulmonary venous pressure
c. Long period of time where the lung is
unventilated
d. Alveolar oedema

154
Q

When producing a pressure-volume loop for the measurement of static lung compliance ninja nerd

A

measurements of volume and intrapleural
pressure are taken as the subject holds his
breath because then alveolar pressure is zero

155
Q

Surfactant Function ninja nerd

A

more effective at lowering the surface tension as the alveoli and airways get smaller in expiration

156
Q

ow static lung compliance ninja nerd

A

a. Can often be deduced from measurements of lung volumes and from forced expiratory spirograms, without a formal measurement of lung compliance

157
Q

Some of the features regarding
Pulmonary Resistance? N.N

A

a. Increase in pulmonary arterial pressure generally
cause a fall in pulmonary resistance

b. Pulmonary resistance is only 1/10 of systemic
circulation resistance

c. Increase of lung volume results in decrease of
resistance in extra alveolar vessels
d. Acetylcholine has a good bronchiole smooth
muscle relaxation effect
e. Resistance in pulmonary capillaries increases at
large lung volumes

158
Q

conditions are reasonable
explanations for a patient’s decreased static
pulmonary compliance (the pressure-volume
curve for the lungs shifted to the right)? N.N

A

a. Decreased functional pulmonary surfactant
b. Fibrosis of the lungs
c. Surgical removal of one lobe
d. Pulmonary vascular congestion

159
Q

Regarding compliance N.N

A

compliance

a. functional residual capacity is the equilibrium
volume when elastic recoil of lung is balanced by
normal tendency for chest wall to spring out
b. hysteresis is due to frictional resistance to air
movement
c. compliance is greater in expiration than in
inspiration
d. compliance is increased in emphysema
e. Compliance It is a measure of stretchability/distensibility

o. Depends on the change in volume over the change in pressure

160
Q

emphysema It’s increases lung compliance

chest wall recoil its naturally prefers inward recoils

True /False N.N

A

True

161
Q

Regarding the elastic properties of the lung: N.N

A

surface tension is the force acting across an imaginary line in the surface of the liquid

During deflation, lung volume at any given pressure is slightly greater than it is during inflation

Volume-pressure (VP) curves, referred to as lung compliance

162
Q

What is pulmonary function capacity? N.N

A

INSPIRATORY CAPACITY (IC)

EXPIRATORY CAPACITY (EC)

FUNCTIONAL RESIDUAL CAPACITY (FRC

VITAL CAPACITY (VC

TOTAL LUNG CAPACITY (TLC)

163
Q

What does it mean by tidal volume? N.N

A

Total volume of air inspired and inspired during normal quiet breathing

164
Q

A patient suffers from an acute asthma attack. The patient has no history of COPD. What changes of the respiratory parameters is associate with his asthma attack? N.N

A

FEV1 is decreased???

165
Q

Force of respiratory muscles is dependent on lung volume. At which lung volume have the expiratory muscles their greatest force? N.N

A

RV

166
Q

The airway resistance of a healthy person has to be determined. Close to which lung volume do you expect to measure his highest resistance to expiratory airflow? N.N

A

. 60 % of VC

167
Q

You refer your patient with pulmonary fibrosis to the pulmonary function lab. Which of the following values can be measured using direct spirometry N.N

A

Total lung capacity

168
Q

By a routine examination of respiratory functions, a spirometer is used to measure lung volumes. Which lung volume or lung capacity cannot be determined by this method? N.N

A

. Total lung capacity (TLC)

169
Q

obstructive pulmonary disorder include ? N.N

A

Emphysema o Chronic bronchitis o Asthma

170
Q

In TB, the FVC (L) is decreased true false ?N.N

A

True

& The PFT is >80%

171
Q

Force vital capacity is ? N.N

A

Volume of air a person can forcefully expire and inspire

172
Q

In pulmonary fibrosis ? N.N

A

Increased in lung elasticity leads to decreased in compliance

173
Q

Emphysema is

A

Obstructive disorder with increased compliance

174
Q

. Increase in lung elasticity equals to increase in lung compliance True False N.N

A

Flase

175
Q

A patient has PFT < 80%, what can you suspect from
him? N.N

A

His lung elasticity is high

176
Q

A patient comes to you with a history of chronic
bronchitis, what can you expect to see from his PFT? N.N

A

PFT < 80%

177
Q

what are the components of the alveolar ventilation rate? N.N

A

Tidal volume

Dead space

Dead space

178
Q

what is the direct component that can affect perfusion? N.N

A

Cardiac output

𝐶O= 𝐻R 𝑥𝑥 𝑆V

179
Q

How does oxygen can indirectly cause vasodilation of blood vessel in pulmonary circulation ? N.N

A

Oxygen induces endothelial cell to produce nitric oxide

180
Q

What mechanism that occurs when we have increased ventilation during exercise to maintain V/Q ratio? N.N

A

a) Vasodilation

181
Q

What happens when there’s low oxygen level in blood in systemic circulation and pulmonary circulation? N.N

A

Systemic circulation: vasodilation; pulmonary circulation:
vasoconstriction

182
Q

6) What does carbon dioxide do when the concentration
is high enough to bronchiole smooth muscles?

A

b) It causes bronchiole smooth muscles to relax

183
Q

t and mentioned changes below that is true when bronchiole dilates N.N

A

Increase flow

184
Q

Why does the top of the lung have the lowest perfusion? N.N

A

Because of the gravity pulls down the blood thus it will have high ventilation

185
Q

Regarding the respiratory membrane made of ? N.N

A

There are two types of alveolar cells lining the alveoli

186
Q

The normal thickness of respiratory membrane is ? N.N

A

Around 0.5 -1 micrometers

187
Q

3) Thick respiratory membrane may cause ? N.N

A

Alteration of gas exchange process be more specific

188
Q

3) Thick respiratory membrane may cause ? N.N

A

Alteration of gas exchange process be more specific

189
Q

4) Regarding dyspnea, caused by left sided heart failure true/ False ? N.N

A

True

190
Q

5) In pneumonia the respiratory membrane becomes thinner true / false N.N

A

False

191
Q

The surface area Is inversely proportional to the gas exchange true false N.N

A

False

192
Q

Elastase function is N.N

A

Breaks down elastic fibers caused mostly in smokers due to Deficiency of alpha 1 antitrypsin may cause

193
Q

d. Increase in degradation of anti 1 antitrypsin protease caused by smoking true /False N.N

A

False

194
Q

Regarding the partial pressure of gases in the alveoli, ? N.N

A

a) The pO2 in the alveoli is 40 mmHg

195
Q

2) In external respiration what happen to oxygen ? N.N

A

Oxygen moves from high concentration to low
concentration

196
Q

Regarding partial pressure of oxygen? N.N

A

It is 104 mmHg in alveoli

197
Q

features of the hemoglobin? N.N

A

a) It contains 2 alpha chains
b) There are 4 oxygen binding sites

d) The iron is in the ferrous state

198
Q

5) In the deoxygenated blood T state N.N

A

The hemoglobin has low affinity for oxygen

199
Q

6) Regarding the carbon dioxide distribution, ? N.N

A

70% of the carbon dioxide is in the form of bicarbonate
b)2% of the carbon dioxide is dissolved in the blood
plasma

c) The carbon dioxide bound to amino acids of the globin chain is known as carbamino hemoglobin

200
Q

7) In the oxygenated blood haemoglobin in which state N.N

A

d) The hemoglobin has a high affinity for oxygen

201
Q

Regarding Haldane effect

A

c. The hemoglobin which has low affinity for oxygen becomes
high

202
Q

9) Regarding nitrogen N.N

A

It is one of the most abundant atoms in the alveoli

203
Q

10) In deoxy hemoglobin N.N

A

a) The carbon dioxide is bound to amino acids of the
globin chains
b) The protons are bound to negatively charged amino
acids
c) The 2,3-biphosphoglycerate is bound to positively
charged pocket

204
Q

) Binding of carbon dioxide to the hemoglobin helps in the release of oxygen into the tissues True /False N.N

A

True

205
Q

Pulmonary ventilation is part of the circulatory
system? True /False N.N

A

False
pulmonary ventilation happen in the alveolar not between the alevolar and pulmonary veins
b) External respiration
c) Transport
d) Internal respiration

206
Q

The most important factor that determines how much
oxygen combines with hemoglobin is N.N

A

Oxygen

207
Q

Hemoglobin has a tendency to release oxygen where N.N

A

pH is more acidic

208
Q

Most of the carbon dioxide transported by the blood is N.N

A

converted to bicarbonate ions and transported in plasma /

209
Q

6) Approximately 20% of carbon dioxide is transported in the blood as N.N

A

b. carbaminohemoglobin

210
Q

In the alveoli, the partial pressure of oxygen is N,N

A

d. about 104 mm Hg

211
Q

8) In the internal respiration

A

Oxygen moves from the blood into the tissues

212
Q

9) Regarding the Bohr effect N.N

A

The hemoglobin affinity to oxygen decreases

213
Q

10) Breaking of the iron and oxygen bond is caused by N.N

A

Binding of carbon dioxide to the hemoglobin

214
Q

) Which is an early signs of hypoxia? N.N

A

RATT

Restlessness and certain agitation Anxiety Tachycardia o Heart rate greater than 100 beats per minute Tachypnea o Accelerated respiration o Not to be mistaken with:  Hyperventilation • Excessive increase in pulmonary ventilation that exceeds the metabolic demands of the body and can change the blood chemistry (respiratory alkalosis)  Hyperpnea • Increase in the depth of the respirations (usually after exercise or painful stimuli) that does not change the blood chemistry

215
Q

(B) LATE SIGNS of hypoxia N.N

A

BEDC

Bradycardia

o Heart rate less than 60 beats per minute Extreme restlessness Dyspnea o Gasping to bring the air in Cyanosis o A bluish cast of the skin

216
Q

types of hypoxia ?N.N

A
  1. Hypoxemic hypoxia
  2. Ischemic (stagnant) hypoxia
  3. Anemic hypoxia
  4. Hystotoxic hypoxia
217
Q

cytotoxic hypoxia is type of hypoxia but not stagnant hypoxia True /False

A

False Stagnant hypoxia is type of hypoxia but not cytotoxic hypoxia

218
Q

5) What is the term for lymph in the pleural cavity? N.N

A

Chylothorax

a) Pneumothorax
b) Hemothorax
d) Pyothorax

219
Q

Which drugs is used to treat ischemic hypoxia? N.N

A

a) Tissue plasminogen activator
b) Warfarin
c) Aspirin

220
Q

Which conditions do result in abnormal hemoglobin?

A

a) Folic acid deficiency

c) Thalassemia
d) Sickle cell anemia

221
Q

8) How many oxygen molecules can one RBC bind? N.N

A

d) 1 billion

222
Q

Which organelle is affected by histotoxic hypoxia? N.N

A

b) Mitochondria

223
Q

Which hypoxia is NOT treated with supplemental oxygen? N.N

A

a) Histotoxic
as the tissue are unable to use the oxygen that is being delivered to them

224
Q

The Bohr effect is driven by an increase in what factors? N.N

A

Mnemonic – “CADET” face right -

any increase to the CADET components will cause a shift the curve to the right

o C – CO2 increase

o A – Acidic (Increase in protons)

o D – 2,3 DPG (alternate name to 2,3 BPG) increase

o E – Exercise increase

o T – Temperature increase

● All will give an increased O2 dissociation (therefore a decreased affinity for O2.)

● Therefore, the Bohr effect will assist the body to compensate for energy use.

225
Q

) If a person were to be febrile with temperature, would you expect the percentage of hemoglobin saturation to do what? N.N

A

increase ?
shift the graph to the left

226
Q

If a person were under hypoventilation conditions, would you expect the percentage of hemoglobin saturation to do what? N.N

A

Decreases

227
Q

What is the expected percentage of saturation of hemoglobin in the lungs in a healthy person under normal conditions? N.N

A

98%

228
Q

The blood in the artery travelling to the peripheral tissue has/is what? N.N

A

. More saturated that the venous blood supply ?

229
Q

What center controls prolonged breathing ? N.N

A

Apneustic Centre

  • prolonged inspiration called apneustic breathing
230
Q

An increase in action potential travelling via the phrenic nerves to the diaphragm cause what action N.N

A

The diaphragm to lower

231
Q

. What nuclei in the VRG have leaky cation channels, allowing cations to flow into the neuron, causing spontaneous depolarization, sending action potentials to the external intercostals and diaphragm

in other words what’s the pacemaker neurons ? N.N

A

o Pre-Botzinger Complex

232
Q

.What is the normal respiratory rate set at (eupnea)? N.N

A

The normal respiratory rate (Eupnea)is set by this complex is between 12-16 breaths per minute.

233
Q

5.The Pneumotaxic Centre and Apneustic Centers are both located in the pons? true /false N.N

A

true

The Pneumotaxic Centre is the upper aspect

and Apneustic Centers lower aspect of the Pons

234
Q

Chemoreceptors

A

Cells that respond to chemical compounds to give an impulse to a sensory nerve.

o There are two sets of chemoreceptors.

o O2 receptors which are in the peripheral nervous system.

o CO2 receptors which are found both peripherally and centrally.

235
Q

Stretch receptors

A

o Cells that respond to the stretching of muscles by giving impulses to the central nervous system.

o These receptors are a pivotal part of the proprioception system which coordinates muscle activity.

236
Q

Proprioceptors

A

o Cells that monitor body changes brought about by muscular movement to give an impulse to the central nervous system to co-ordinate movement.

237
Q

Juxtacapillary receptors (J-receptors or pulmonary c-fiber receptors)

A

o Cells that cause an increase in breathing rate as reflex response.

o Thought to be involved in the sensation of dyspnea

238
Q

Nociceptors

A

o Cells that respond to a pain stimulus by giving impulses to the central nervous system.

239
Q

o VRG and DRG both have inspiratory neurons which move downwards and give off fibers into the anterior or ventral grey horn. These specialized cell bodies are somatic motor neurons what happen when they get excited ? N.N

A
  • If exiting through C3-C5, via the phrenic nerve, the signals carry to the cervical plexus and diaphragm
  • If exiting through T1-T11, via the intercostal nerves, they will carry to the external intercostals. Stimulating inspiration
240
Q

Without the dopamine being released, the cranial
nerves will not be stimulated. What are the overall
effects of this? N.N

A

a) decrease ventilation
b) increase carbonic acid
c) increase blood pCO2

241
Q

The peripheral chemoreceptors are stimulated by N.N

A

Increase in protons

242
Q

The peripheral chemoreceptors are inhibited by N.N

A

d. Decrease in protons

243
Q

4) Regarding pCO2, 70% affect the central chemoreceptors true/ False ?N.N

A

70% affect the central chemoreceptors

244
Q

Regarding carotid bodies of the peripheral
chemoreceptors, a. Send impulses through the 9th cranial nerve true/ False ? N.N

A

True

245
Q

6) In hypercapnia, The CO2 can cross the blood brain barrier true/ False ? N.N

A

ttrue

246
Q

7) Stimulation of central chemoreceptors cause ? N.N

A

Stimulation of DRG and pneumotaxic centre

247
Q

8) features Regarding central chemoreceptors, N.N

A

a) Can be found in CSF
b) It is stimulated by high blood pCO2
d) It is inhibited by low blood pCO2

248
Q

features Regarding oxygen,N.N

A

a) Stimulation of the chemoreceptors occur when the
level is < 60 mmHg

249
Q

In hypocapnia, there is N.N

A

a) There is decrease in carbonic acid
b) The pH level is high
c) The protons level is low

250
Q

Regarding the hypothalamus, what are some of the features N.N

A

Stimulated by stimulation of thermoreceptors causing …….

Its associated with the limbic nuclei

251
Q

Receptors found in the lung include N.N

A

a) Irritant receptors
b) Stretch receptors

d) Juxta capillary receptors

252
Q

3) Features Regarding stretch receptors, N.N

A

Located in two locations

o Within visceral pleura

o Smooth muscle of bronchi and bronchioles

  • Associated with Herring Breuer reflex

Stimulated when the tidal volume > 800 ml sends signals to the cranial nerve X (vagus nerve)

+ inhibit DRG o Will also inhibit VRG  inhibition of inspiratory neurons & stimulation of the expiratory neurons → causing expiration

253
Q

Features of irritant receptors, N.N

A

b) Located under the epithelial layer of the mucosa
c) Sends impulse through the 10th cranial nerve (vagal nerve )
d) Stimulation cause cough reflex

254
Q

J fibers of juxta capillary receptors N.N

A

a. They have two fibers: o J fibers o C fibers
b. Are located within the interstitial fluids
c. The lung parenchyma

 The alveoli and respiratory bronchioles

 Sites of gas exchange

d. They respond to fluid accumulation which include

o Pulmonary edema

o Pneumonia

255
Q

what happen during Pulmonary edema N.N

A

a) Cause stimulation of the juxta capillary receptor
b) May be caused by left sided heart failure
c) Causes thickening of the respiratory membrane

256
Q

7) Fluid accumulation causes N.N

A

Rapid and shallow breathing

Dyspnea → shortness of breath (gasping of air)

as result of

257
Q

What is hyperpnea,N.N

A

a) It is caused by the stimulation of proprioceptors of the skeletal muscles

b) It is normal during exercise
d) It the increase in respiration rate and depth

258
Q

9) Impulse from the cerebral cortex can N.N

A

Can bypass the respiratory centers

259
Q

what stimulate the limbic nuclei N.N

A

emotions

260
Q

Which metabolic disorder is caused in high altitudes? n.n

A

Metabolic Alkalosis

261
Q

Hypoxia causes what in the lung? N.N

A

Vasoconstriction

262
Q

Stimulation of neural respiratory center cause N.N

A

) Hyperventilation and Hypoventilation periodically

263
Q

two main respiratory centres in the brain N.N

A

Medullary Respiratory Centers

(i) DRG- Dorsal Respiratory Group of Neurons (ii) VRG- Ventral Respiratory Group of Neurons (iii) CCR- Central Chemoreceptors
(2) Pontine Respiratory Centers
(i) Apneustic center (c1-C (ii) Pneumotaxic center (T1-T11)

264
Q

HYPOXIA Decreased PO2 which mechanism will compensate in this situation N.N

A
  • EFFECT OF HYPOXIA ON PERIPHERAL CHEMORECEPTORS
  • EFFECT OF HYPOXIA ON RESPIRATORY CENTERS
265
Q

DECREASED PCO2 which mechanism will compensate in this situation N.N

A

A) CENTRAL CHEMORECEPTORS

B) EFFECT OF ↓ CO2 ON RESPIRATORY CENTERS

(C) RESPIRATORY ALKALOSIS

266
Q

ACCLIMATIZATION which mechanism will compensate in this situation N.N

A

(A) KIDNEY

(B) V/Q COUPLING

(C) ENDOTHELIAL CELLS OF BLOOD VESSELS

VEGF and (PDGF)

(D) BABIES BORN AT HIGH ALTITUDES Strong Ventricles

267
Q

the nervous control of
respiration during exercise n.n

A

Respiratory centers

o Ventral and dorsal respiratory group (VRG and DRG)  Located in the medulla

o Central chemoreceptors (CCR)  Located posterior to the DRG

o Pneumotaxic and apneustic center  Located in the pons

268
Q

What happen during exercise ?N.N

A

Arterial PO2 and PCO2 DONT CHANGEA during exercise
b. Hyperpnea is defined as increased alveolar ventilation
without any change in blood gas chemistry
c. The primary somatosensory cortex receives
proprioceptive information from the spinothalamic tract

269
Q

The carotid and aortic bodies send impulses to [what
cranial nerve] and [what cranial nerve], respectively. n.n

A

CN IX, CN X

270
Q

ACUTE MOUNTAIN SICKNESS which would it lead to and how to treat it

A

a)Cerebral Edema

which treated with

Acetazolamide (ii) Supplemental oxygen (iii) Mannitol (iv) Dexamethasone

b) Pulmonary Edema

271
Q

The myoglobin dissociation curve

A

A hyperbolic curve

272
Q

The Bohr effect on the haemoglobin dissociation curve.

A

A sigmoid curve, shifted right

273
Q

Chronic adaptations to hypoxia (e.g mountain sickness)

A
  • Increased RBC production
  • Increased 2,3 BPG produced within RBC - O2 offloaded more easily into tissues
  • Increased number of capillaries
  • Increased number of mitochondria - O2 used more efficiently
  • Kidneys conserve acid - decrease arterial pH
274
Q

Acute mountain sickness symptoms

A

Fatigue, headache, tachycardia, dizziness and shortness of breath, slipping into unconsciousness.

275
Q

These chemoreceptors, when stimulated, can compensate for metabolic acidosis by triggering increased elimination of CO2.

A

Peripheral chemoreceptors

276
Q

hyperinflated lungs think

A

emphysema

277
Q

Causes also cause shortness of breath on exertion, a restrictive defect on spirometry and reduced pulmonary compliance but no sign of infection.

A

Pulmonary Fibrosis

278
Q

he maximum total volume of air that can be inspired at the end of a normal, quiet respiration.

A

Inspiratory capacity

279
Q
  1. The volume of air in the lungs after a maximal expiration.
  2. The volume of air in the lungs at the end of a normal, passive expiration.
A
  1. Residual volume
  2. Functional residual capacity (include some air from expiration)
280
Q

right horizontal fissure is displaced indicate

A

Right Upper lung collapse

281
Q

Lingular pneumonia

A

infection of the lingual lobe (small angle extended from lung tissue)
this can be CXR as the left heart border is obscured.

282
Q

veil-like opacity.

A

is siang indicating Left upper lobe collapse

The Respiratory System (19 decks)

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