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Phoebe's Resp > Physiology > Flashcards

Physiology Flashcards

1
Q

Internal respiration refers to the intracellular organisms which

A

consume O2 and produce CO2

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2
Q

External respiration refers to the sequence of events that leads to

A

the exchange of O2 and CO2 between external environment and the cells of the body

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3
Q

4 steps of external respiration

A
  1. Ventilation
  2. Gas exchange between alveoli and blood
  3. Gas transport in blood
  4. Gas exchange at tissue level
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4
Q

Ventilation

A

Process of moving gas in and out of lungs

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5
Q

Boyle’s Law

A

At any constant temperature the pressure exerted by a gas varies inversely with the volume of the gas

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6
Q

Linkage of Lungs to Thorax

A
  1. Intrapleural fluid cohesiveness

2. Negative intrapleural pressure

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7
Q

Intrapleural fluid cohesiveness

A

Water molecules in intrapleural fluid are attracted to each other and resist being pulled apart
Pleural membranes stick together

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8
Q

Negative intrapleural pressure

A

Below atmospheric pressure in intrapleural space creates a transmural pressure gradient across lung wall and chest wall
Lungs expand and chest tightens

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9
Q

Inspiration

A 
Active
Volume of thorax increases
External intercostal muscles contract
Ribs move up and out
Diaphragm contracts (phrenic nerve from C3,C4,C5)
Intra-alveolar pressure falls
Air enters lungs down pressure gradient
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10
Q

Expiration

A

Passive
Lungs recoil to normal size
Alveolar pressure rises
Air leaves down pressure gradient

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11
Q

Pneumothorax

A

Air in pleural space

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12
Q

Complications of pneumothorax

A

Can cause lung to collapse

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13
Q

Treatment of tension pneumothorax

A

Decompression by insertion of IV cannula in 2nd intercostal space, midclavicular line, on affected site

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14
Q

Causes of tension pneumothorax

A 
Asthma
Injury penetrating chest
Rupture of sub-pleural pleb
TB
Infection
Growth (Carcinoma)
Hereditary
Tissue (connective)
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15
Q

Presentation of tension pneumothorax

A 
Pleuritic chest pain
Tracheal deviation
Hyper-resonance
Onset sudden
Reduced breath sounds
Asymptomatic sometimes
Xray shows collapse
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16
Q

What causes recoil during expiration?

A

Alveolar surface tension

Elastic connective tissue in lungs

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17
Q

Alveolar surface tension

A

Attraction between water molecules at liquid air interface

Produces a force in alveoli that resists stretching of lungs

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18
Q

Law of LaPlace

A

Smaller alveoli are more likely to collapse

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19
Q

Pulmonary surfactant

A

Complex mixture of lipids and proteins secreted by type II alveoli
Lowers alveolar surface tension
Lowers that of smaller alveoli more, preventing them from collapsing

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20
Q

Respiratory Distress Syndrome in New Born

A

Foetal lungs unable to produce surfactant
Causes RDS
Baby makes strenuous respiratory efforts to overcome high surface tension

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21
Q

Alveolar interdependance

A

If an alveolus starts to collapse, the surrounding alveoli are stretched and then recoil, bringing collapsing alveoli with them to reopen it

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22
Q

Major inspiratory muscles of respiration

A

Diaphragm and external intercostal muscles

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23
Q

Accessory muscles of inspiration

A

Sternocleidmastoid, scalenus, pectoral

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24
Q

Muscles of active expiration

A

Abdominal muscles and internal intercostal muscles

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25
Q

tidal volume

A

Volume of air entering or leaving lungs in a single breath

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26
Q

Residual volume

A

minimum volume of air remaining in lungs after maximal expiration

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27
Q

Inspiratory capacity

A

maximum volume of air that can be inspired at the end of a normal expiration

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28
Q

Total lung capacity

A

Vital capacity + residual volume

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29
Q

FVC

A

Forced vital capacity

Maximum volume that can be forcibly expelled from lungs following maximum inspiration

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30
Q

FEV/FEC

A

should be >70%

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31
Q

parasympathetic stimulation causes

A

bronchoconstriction

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32
Q

sympathetic stimulation causes

A

bronchodilatation

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33
Q

Pulmonary compliance

A

Measure of effort that has to go into stretching of distending the lungs
Less compliant = more work required

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34
Q

Increased pulmonary compliance

A

Emphysema

Patients have to work harder to inflate lungs

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35
Q

Decreased pulmonary compliance

A

Pulmonary fibrosis, pulmonary oedema, pneumonia

Shortness of breath

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36
Q

Pulmonary ventilation

A

Volume of air breathed in and out per minute

Tidal volume x resp rate

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37
Q

Alveolar ventilation

A

Volume of air exchanged between atmosphere and alveoli per minute

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38
Q

Ventilation

A

Rate at which gas passes through lungs

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39
Q

Perfusion

A

Rate at which blood passes through lungs

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40
Q

Alveolar Dead Space

A

Ventilated alveoli that aren’t adequately perfused with blood

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41
Q

Perfusion > ventilation

A

Increased Co2
Dilatation of airways
Decreased O2
Constriction of blood vessels

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42
Q

Ventilation > perfusion

A

Decreased Co2
Constriction of airways
Increased O2
Dilatation of blood vessels

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43
Q

4 factors affecting Rate of Gas Exchange Across Alveolar Membrane

A
  1. Partial pressure gradient of O2 and Co2
  2. Diffusion coefficient for Co2 and O2
  3. Surface area of alveolar membrane
  4. Thickness of alveolar membrane
44
Q

Daltons Law

A

Total pressure exerted by a gaseous mixture = sum of all partial pressures of each individual gas

45
Q

Alveolar Gas Equation

A

PAO2 =

PiO2 - (PaCO2/0.8)

46
Q

Diffusion coefficient for Co2

A

Solubility of Co2 in membranes

20 X that of O2

47
Q

Large gradient between PAO2 and PaO2

A

Problems with gas exchange in lungs or a right to left shunt in heart

48
Q

Henry’s Law

A

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

49
Q

2 forms O2 present in blood

A

Bound to haemoglobin

Physically dissolved

50
Q

Oxygen binding to haemoglobin

A

Binds reversibly

Each Hb has 4 haem groups

51
Q

Oxygen delivery index

A

DO2I = CaO2 X CI

52
Q

Oxygen delivery to tissues can be impaired by

A

Respiratory disease
Heart Failure
Anaemia

53
Q

Sigmoid curve of haemoglobin

A

Binding of one O2 to haemoglobin increases affinity of Hb for O2
Flattens when all sites occupied

54
Q

Bohr Effect

A

Shift of haemoglobin curve to right

55
Q

Foetal haemoglobin

A

Higher affinity for O2, curve shifted to left

Allows mother to transfer O2 at low partial pressures

56
Q

Myoglobin

A 
Present in skeletal and cardiac muscles
One haem group per myoglobin molecules 
Dissociation curve hyperbolic 
Releases O2 at VERY LOW pO2
Provides short term storage of O2 for anaerobic conditions
57
Q

Presence of myoglobin in blood indicates

A

Muscle damage

58
Q

Ways Co2 is transported around blood

A

Solution (10%)
As bicarbonate (60%)
As carbamino compounds (30%)

59
Q

Co2 as bicarbonate

A

Co2 + H20 -> H2Co3

60
Q

Catalyst for Co2 forming a bicarbonate

A

Carbonic Anhydrase

61
Q

Where does Co2 become H2Co3

A

Red blood cells

62
Q

How are carbanimo compounds formed

A

Combination of Co2 with terminal amine groups in blood proteins
Especially globin from haemoglobin

63
Q

Haldane Effect

A

Removing O2 from Hb increases ability of Hb to pick up Co2 and Co2 generated H+

64
Q

The Bohr Effect and Haldane Effect work in synchrony to facilitate

A

O2 liberation and uptake of Co2

65
Q

How does the Bohr Effect facilitate the removal of O2

A

Shifts curve to right meaning Hb has a lower affinity to O2

66
Q

Neural control of rhythm of heart

A

Medulla

Pre-Botzinger complex

67
Q

How is rhythm generated by Pre-Botzinger Complex

A
  1. Excites dorsal respiratory group neurones
  2. Fire in bursts
  3. Firing leads to contraction of inspiratory muscles
  4. When firing stops = passive expiration
68
Q

Pneumotaxic centre

A

Stimualtion terminates inspiration
Occurs when dorsal neurones fire
Prevents inspiration being too long - deep breaths (apneusis)

69
Q

Examples of involuntary modifications of breathing

A
  1. Pulmonary stretch receptors
  2. Joint receptors reflex in exercise
  3. Cough reflex
70
Q

Pulmonary Stretch Receptors

A

Activated during inspiration
Afferent discharge inhibits inspiration
Hering Breur Reflex
DOESN’T HAPPEN NORMALLY, BABIES

71
Q

Joint receptors

A

Impulses from moving limbs increase breathing

Increased ventilation during exercise

72
Q

Increased ventilation during exercise

A

Adrenaline released
Impulses from cerebral cortex
Increase body temp
Accumulation of Co2 and H+ created by active muscles, that must be removed

73
Q

Cough reflex

A

Afferent discharge stimulates:

  1. Short intake of breath
  2. Closure of larynx
  3. Contraction of abdominal muscles
  4. Increases alveolar pressure
  5. Opening of larynx and expulsion of air at high speed
74
Q

Peripheral Chemoreceptors

A

Sense tension of oxygen, Co2 and H+ in blood

Found in carotid bodies and aortic bodies

75
Q

Central Chemoreceptors

A

Respond to H+ in cerebrospinal fluid

Found near surface of medulla

76
Q

Cerebospinal fluid

A

Separated by blood brain barrier
Co2 diffuses readily
Responsive to PCo2

77
Q

Rise in arterial PCo2 results in

A

increased ventilation

78
Q

Fall in arterial PO2 results =

A

Hypoxia

Stimulates peripheral chemoreceptors

79
Q

When are peripheral chemoreceptors stimulated

A

<0.8 Kpa

80
Q

Hypoxic Drive

A

Important in high altitudes

81
Q

Rise in H+ only

A

Stimulates peripheral receptors
Causes hyperventilation
Increase elimination of Co2 from body

82
Q

Chronic adaptations of hypoxia

A

Increased RBC production
Increased number of capillaries
Increased number of mitochondria
Kidneys converse acid (Arterial pH drops)

83
Q

Type 1 Respiratory Failure

A

Short of oxygen

Hypoxia

84
Q

Type 2 Respiratory Failure

A

Short of Oxygen
Too much Co2
Hypoxia + Hypercapnia

85
Q

Hypercapnia

A

Too much Co2

86
Q

V/Q mismatch

A

ventilation and perfusion not matched

87
Q

Restrictive thoracic disease causes outwith the lungs

A

Skeletal
Muscle Weakness
Obesity

88
Q

DPLD

A

Diffuse Parenchymal Lung Disease
or
Interstitial Lung Disease
Group of disease that effect the interstitum (tissue space around alveoli)

89
Q

Effort Dependant Pulmonary Function Tests

A 
FEV
Flow rates (spirometry)
90
Q

Effort Independant Tests

A 
Relaxed vital capacity (spirometry)
Helium/N2 washout static lung volumes
Whole  body plethysmography
Impulse oscillometry
Exhaled nitric oxide
Gas diffusion tests
91
Q

Spirometry Graph for Asthma and COPD

A

Asthma depressed but ends same volume

COPD ends lower volume

92
Q

Obstructive Disease Lung Function Patterns

A

PEFR decreased
FEV decreased
FVC normal in asthma, decreased in COPD
FEV/FVC = <75%

93
Q

Restrictive Disease Lung Function Patterns

A

PEFR normal
FEV decreased
FVC decreased
FEV/FVC = >74%

94
Q

Forceful expiration

A

Active process controlled by firing ventral neurons in the medulla

95
Q

Results in increased pulmonary compliance, produces overinflated lungs and will show an obstructive defect on spirometry

A

Emphysema

96
Q

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

A

pulmonary fibrosis

97
Q

Will show low FVC, low FEV and low FEV/FVC%

A

Combined restrictive lung disease

98
Q

Chronic adaptation by hypoxia

A

Increased mitochondria, 2,3-BGP capillaries and polycythaemia with a metabolic acidosis

99
Q

Acute mountain sickness

A

Fatigue, headache, tachycardia, dizziness and shortness of breath, slipping into unconciousness

100
Q

Diabetic Ketosis

A

Hyperventilation with severe metabolic acidosis

101
Q

Chemoreceptors that detect arterial oxygen partial pressure and cause hyperventilation and increased cardiac output

A

Peripheral Chemoreceptors

102
Q

Chemoreceptors found in brainstem. Respond to CSF

A

Central chemoreceptors in medulla

103
Q

Chemoreceptors that when stimulated can compensate for metabolic acidosis by increasing elimination of Co2

A

Peripheral Chemoreceptors

104
Q

Volume of air left in lungs after maximal expiration

A

Residual volume

105
Q

Sum of inspiratory reserve volume, tidal volume and expiratory reserve volume

A

Vital capacity

106
Q

Volume of air left in lungs after normal expiration

A

Functional residual capacity

Phoebe's Resp (23 decks)

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