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Physiology Flashcards

1
Q

Internal respiration

A

The intracellular mechanisms that consumes O2 and produces CO2

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2
Q

External respiration

A

The sequence of events that leads to the exchange of O2 and CO2 between the external environment and cells of the body

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3
Q

4 steps in external respiration

A

Ventilation - Mechanical process of moving air between the atmosphere and alveolar sacs
Gas exchange between alveoli & blood in pulmonary capillaries
Gas binding and transport in circulating blood
Gas exchange between blood in systemic capillaries & tissue

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4
Q

4 body systems involved in external respiration

A

Respiratory
Cardiovascular
Haematology
Nervous

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5
Q

Boyle’s Law

A

P1V1=P2V2 (When T is constant)

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6
Q

Must the intra-alveolar pressure be more/less than atmospheric pressure for air to flow into the lungs

A

LESS

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7
Q

Forces holding thoracic wall and lungs in opposition (2)

A

Intrapleural fluid cohesiveness

Negative intrapleural pressure (negative in comparison to atmosphere)

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8
Q

Intrapleural fluid cohesiveness (2)

A

Water molecules in intrapleural fluid are attracted to each other
So pleural membranes stick together

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9
Q

Negative intrapleural pressure (2)

A

Sub-atmospheric intrapleural pressure create a transmural pressure gradient across the lung and chest wall
So the lungs are forced to expand outwards while the chest is forced to squeeze inwards

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10
Q

Atmospheric pressure at sea level (2)

A

760mmHg

101kPa

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11
Q

Intra-alveolar (intrapulmonary) pressure

A

Same as atmospheric pressure when equilibriated

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12
Q

Intrapleural (intrathoracic) pressure

A

756mmHg

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13
Q

Inspiration mechanism (4)

A

Active process depending on muscle contraction
Thorax volume is increased vertically by diaphragm contraction
Involves phrenic nerve from cervical 3,4 & 5
External intercostal muscle contraction lifts ribs and moves out of sternum - ‘Bucket handle’ mechanism

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14
Q

Before inspiration

A

External intercostal muscle and diaphragm are relaxed

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15
Q

During inspiration (3)

A

External intercostal muscles contract to elevate ribs and increase side-to-side thoracic cavity dimensions
Diaphragm lowering on contraction increases vertical thoracic cavity dimension
Ribs elevation lifts sternum upwards and outwards that increases front to back thoracic cavity dimension

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16
Q

Inspiration pressure changes (2)

A

Increase in lung size makes intra-alveolar pressure to fall

Air then enters down pressure gradient until equilibrium is reached

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17
Q

Expiration (4)

A

Passive process caused by intercostal muscles relaxing and diaphragm moving upwards
Chest wall and lungs recoil to preinspiratory size due to elastic properties
The recoil increases intra-alveolar pressure
So air leaves lungs down pressure gradient until equilibrium is reached

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18
Q

Pneumothorax (7)

A

Air in pleural space
Can be spontaneous, traumatic or iatrogenic
Air enters the pleural space from outside or from the lungs
This can abolish transmural pressure gradient leading to lung collapse
Small pneumothorax can be a symptomatic
Symptoms of pneumothorax include shortness of breath and chest pain
Physical signs include hyper resonant percussion note and decreased/absent breath sounds

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19
Q

What causes lung recoil during expiration (2)

A

Elastic connective tissue

Alveolar surface tension

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20
Q

Alveolar surface tension (3)

A

Attraction between water molecules at liquid air interface
This produces a force which resists lung stretching
If the alveoli were lined with water alone the surface tension would be too strong so the alveoli would collapse

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21
Q

LaPlace’s Law

A

P (Inward directed collapsing pressure) =2(Surface tension)/(Radius of buble)

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22
Q

Pulmonary surfactant (3)

A

Complex mixture of lipids and proteins secreted by type 2 alveoli
Lowers alveolar surface tension by interspersing between water molecules lining the alveoli
More effective with smaller sized alveoli to prevent collapsing and emptying of air content to larger alveoli

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23
Q

Respiratory Distress Syndrome of the New Born (3)

A

Developing fetal lungs are unable to synthesize surfactant until late in pregnancy
Premature babies will lack pulmonary surfactant
So baby has to make hard inspiratory efforts to overcome high surface tension and inflate the lungs

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24
Q

Alveolar Interdependence

A

If an alveolus start to collapse the surrounding alveoli are stretched and then recoil exerting expanding forces in the collapsing alveolus to open it

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25
Q

Forces keeping alveoli open (3)

A

Transmural pressure gradient
Pulmonary surfactant
Alveolar interdependence

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26
Q

Forces promoting alveolar collapse (2)

A

Elasticity of stretched lung connective tissue

Alveolar surface tension

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27
Q

Major inspiratory muscles

A

Diaphragm and external intercostal muscles

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28
Q

Accessory muscles of inspiration

A

Sternocleidomastoid, scalenus, pectoral

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29
Q

Muscles of active expiration

A

Abdominal muscles and internal intercostal muscles

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30
Q

Tidal Volume (TV) (2)

A

Volume of air entering or leaving lungs during a single breath
Average value at 0.5 L

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31
Q

Inspiratory reserve volume (IRV) (2)

A

Extra volume of air that can be maximally inspired over and above the typical resting tidal volume
Average value at 3.0 L

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32
Q

Expiratory reserve volume (ERV) (2)

A

Extra volume of air that can be actively expired by maximal contraction beyond the normal volume of air after a resting tidal volume
Average value at 1.0 L

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33
Q

Residual Volume (RV) (3)

A

Minimum volume of air remaining in the lungs even after a maximal expiration
Average value at 1.2 L
Increases when elastic recoil of lungs is lost

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34
Q

Inspiratory Capacity (IC) (3)

A

Maximum volume of air that can be inspired at the end of a normal quiet expiration
(IC =IRV + TV)
Average value at 3.5 L

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35
Q

Functional Residual Capacity (FRC) (3)

A

Volume of air in lungs at end of normal passive expiration
(FRC = ERV + RV)
Average value at 2.2 L

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36
Q

Vital Capacity (VC) (3)

A

Maximum volume of air that can be moved out during a single breath following a maximal inspiration
(VC = IRV + TV + ERV)
Average value at 4.5 L

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37
Q

Total Lung Capacity (TLC) (3)

A

Total volume of air the lungs can hold
(TLC = VC + RV)
Average value at 5.7 L

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38
Q

Can residual volume be measured by spirometry

A

NO so not possible to measure total lung volume by spirometry

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39
Q

Volume time curves determines (4)

A

Forced Vital Capacity (maximum volume that can be forcibly
expelled from the lungs following a maximum inspiration)
Forced Expiratory volume in one second (volume of air that can be expired during the first second of expiration in an FVC determination)
FEV1/FVC ratio (the proportion of the Forced Vital Capacity that can be expired in the first second -normally more than 70%)
Volumes useful in diagnosis of Obstructive and Restrictive Lung Disease

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40
Q

Flow formula

A

F = Change in Pressure/Resistance

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41
Q

Airway resistance (5)

A

Normally low and air moves with small pressure gradient
Primary determinant is radius of conducting airway
Parasympathetic stimulation causes bronchoconstriction
Sympathetic stimulation causes bronchodilatation
Diseases like COPD increases resistance than makes expiration harder than inspiration

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42
Q

Dynamic airway compression during active expiration (3)

A

Rising pleural pressure pushes air out of alveoli but compresses the airway
In healthy people it is no issue for increased airway resistance increases airway pressure upstream which helps open airway by increasing driving pressure
If obstruction present driving pressure is lost where a fall in airway pressure results in compression due to rising pleural pressure

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43
Q

Diseased airway more likely to collapse (True/False)

A

True

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44
Q

Peak flow Meter (4)

A

Assess airway function
Useful in patients with obstructive lung disease
Measured by patient giving short sharp blow into meter
Best out of 3 attempts is taken

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45
Q

Pulmonary Compliance (3)

A

Measure of effort lungs has to go into stretching or expanding
Volume change per unit of pressure change across the lungs
The less compliant the lungs the more work is required to produce a degree of inflation

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46
Q

Decreased pulmonary compliance (3)

A

Caused by fibrosis, oedema, lung collapse, pneumonia, lack of surfactant
Indicates greater pressure change needed to produce a given change in volume - causes SOB
Causes restrictive pattern of lung volumes

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47
Q

Increased pulmonary compliance (3)

A

Caused by lost of elastic recoil
Occurs in emphysema where patients work harder to force air out (hyperinflation)
Increases with increasing age

48
Q

Work of breathing is increased when (4)

A

Pulmonary compliance is decreased
Airway resistance is increased
Elastic recoil is decreased
There is a need for increased ventilation

49
Q

Pulmonary Ventilation (2)

A

Volume of air breathed in and out per minute

= Tidal Volume*Respiratory Rate

50
Q

Alveolar Ventilation (4)

A

Volume of air exchanged between the atmosphere and alveoli per minute
Less than pulmonary ventilation due to anatomical dead space
= (Tidal Volume-Dead space Volume)*Respiratory Rate
More vital as it determines new air available for gas exchange

51
Q

Way to increase pulmonary ventilation

A

Increase depth and rate of breathing

52
Q

Gas transfer between body and atmosphere depends on (2)

A

Ventilation - Rate of gas passing through lungs

Perfusion - Rate of blood passing through lungs

53
Q

Ventilation Perfusion (3)

A

Both blood flow and ventilation vary from bottom to top of the lung
Causes average arterial and alveolar partial pressure of O2 to be different
Significant in disease

54
Q

Alveolar Dead Space (4)

A

Match of alveoli air and blood is not perfect
Ventilated alveoli which are not adequately perfused with blood are considered as alveolar dead space
In healthy people space is tiny
More significant in disease

55
Q

Ventilation Perfusion Match in Lungs (3)

A

Local controls act on smooth muscles of airways and arterioles to match airflow to blood flow
Accumulation of CO2 in alveoli due to increased perfusion decreases airway resistance causing increased airflow
Increase in alveolar O2 concentration due to increased ventilation causes pulmonary vasodilation which increases blood flow to match larger airflow

56
Q

Area that perfusion is greater than ventilation (Applies vice versa) (6)

A 
CO2 increase in area
Local airway dilation
Airflow increases
O2 decrease in area
Local blood vessels constrict
Blood flow decreases
57
Q

Do systemic arterioles constrict/dilate under low O2 concentration

A

Dilate

58
Q

4 factors affecting gas exchange rate across alveolar membrane

A

Partial Pressure Gradient of O2 and CO2
Diffusion Coefficient for O2 and CO2
Surface Area of Alveolar Membrane
Thickness of Alveolar Membrane

59
Q

Partial Pressure of Gas (2)

A

The pressure that one gas in a mixture of gases would exert if it were the only gas present in the whole volume occupied by the mixture at a given temperature
Determines pressure gradient of that gas

60
Q

Dalton’s Law of Partial Pressure

A

P(Total)=P1 + P2 + P3
(Sum of the partial pressures of
each individual component in
the gas mixture)

61
Q

Alveolar Gas Equation

A

PAO2 = PiO2 – [PaCO2/0.8]
PAO2 = Partial Pressure of O2 in alveolar air
PiO2 = Partial pressure of O2 in inspired air
PaCO2 = Partial pressure of CO2 in arterial blood
0.8 is the Respiratory Exchange Ratio (RER)

62
Q

Partial Pressure of Oxygen in the Alveolar air (PAO2)

A

Water vapour in lungs has pressure of 47 mmHg
So pressure of inspired air = 760(atm)-47=713 mmHg (at sea level)
PiO2 = 713*0.21 = 150 mmHg
Normal arterial PCO2 is 40 mmHg
PAO2 = 150 - (40/0.8) = 100 mmHg at sea level

63
Q

Why is Partial pressure gradient of CO2 smaller than O2 (3)

A

CO2 is more soluble than O2
Solubility of gases in membrane is the diffusion constant
Diffusion constant of CO2 is 20 times more than O2

64
Q

A big gradient between PAO2 and PaO2 indicates (2)

A

Gas exchange issues in lungs

Right/left shunt in heart

65
Q

Lung Adaptations to increase SA (3)

A

Airways divide repeatedly
Small airways form outpockets
Extensive capillary network

66
Q

Lung Adaptations to decrease diffusion path (3)

A

Thin walled alveoli consist of single layer of type 1 alveolar cells
Capillaries encircle each alveolus
Narrow interstitial space

67
Q

Non respiratory functions of respiratory systems (5)

A 
Route of heat elimination by water loss
Enhances venous return
Maintain acid-base balance
Enables speech
Defends against inhaled foreign matter
68
Q

Henry’s Law

A 
The amount of a given gas dissolve 
in a given type and volume of liquid 
 at constant 
temperature is 
proportional to the partial pressure 
of the gas in equilibrium with the 
liquid
69
Q

Dissolved oxygen volume and partial pressure

A

3 ml per L

13.3 kPa

70
Q

Normal O2 concentration is arterial blood

A

200 ml per L

71
Q

O2 is present in the blood in 2 forms:

A

Bound to haemoglobin - 98.5%

Physically dissolved - 1.5%

72
Q

Haemoglobin and oxygen (4)

A

Each Hb molecule has 4 haem group
Each haem group reversibly binds to one O2 molecule
Haemoglobin is fully saturated when all Hb present is carrying its maximum O2 load
Partial pressure of O2 is primary factor of percent saturation of haemoglobin with O2

73
Q

Oxygen Delivery Index formula

A 
DO2I = CaO2 x CI
DO2I = Oxygen Delivery Index (ml/min/metre2) 
CaO2 = Oxygen content of arterial blood (ml/L)
CI = Cardiac index (L/min/metre2)
74
Q

Cardiac Index (2)

A

Relates to cardiac output to body surface area

Normal range is 2.4 - 4.2

75
Q

Oxygen Content of Arterial Blood Formula

A 
CaO2 = 1.34 x [Hb] x SaO2
One gram of Hb carry 1.34 ml of O2 
when fully saturated 
[Hb] = haemoglobin concentration (gram/L)
SaO2 = %Hb saturated with O2
76
Q

Oxygen delivery to tissues is impaired by (3)

A

Respiratory disease - Decreased partial pressure of inspired O2 affecting arterial PO2
Heart failure - Decreased cardiac output
Anaemia - Decreased Hb concentration

77
Q

Partial Pressure of inspired O2 depends on (2)

A

Total pressure

Proportion of O2 in gas mixture

78
Q

Haemoglobin Oxygen binding (3)

A

Binding of 1 O2 to Hb increases affinity of Hb for O2 - Co-operativitty
Causes sigmoid curve shape
Flattens when all sites are occupied

79
Q

Flat upper portion on sigmoid curve indicates

A

Moderate fall in alveolar PO2 will not much affect oxygen loading

80
Q

Steep lower part on sigmoid curve indicates

A

Peripheral tissues get a lot of oxygen for a small drop in capillary PO2

81
Q

Bohr Effect

A

When the curve shifts to the right

82
Q

Conditions for Bohr Effect (4)

A

Increased PCO2
Decrease pH
Increased temperature
Increased 2,3 - Biphosphoglycerate

83
Q

Foetal Haemoglobin (HbF) (4)

A

Has different Hb structure to adults (2 alpha, 2 gamma subunits)
Causes less interaction with 2,3 - Biphosphoglycerate
So HbF has higher affinity for O2 even at low PO2
Shifts Bohr effect to the left

84
Q

Myoglobin (Mb) (7)

A

Present in skeletal and cardiac muscle
Only 1 haem group per molecule
No cooperative binding
Hyperbolic dissociation curve
Releases O2 at very low PO2
Short term storage of O2 during anaerobic conditions
Presence in blood indicates muscle damage

85
Q

3 types of CO2 transport in the blood

A

Solution - 10%
Bicarbonate - 60%
Carbamino compounds - 30%

86
Q

CO2 in solution (2)

A

Based on Henry’s Law

20 times more soluble than O2

87
Q

CO2 as bicarbonate (2)

A

Most CO2 is transported this way

Occurs in RBCs

88
Q

Bicarbonate formation formula (2)

A

CO2 + H2O<=>H2CO3
<=>H+ + HCO-3
Involved enzyme carbonic anhydrase in the first equilibrium

89
Q

Bicarbonate formation mechanisms (3)

A

CO2 diffuses from capillary into RBC
CO2 reacts with H2O with carbonic anhydrase to form H2CO3
H2CO3 then dissociates to H+ which is buffered by haemoglobin and HCO3- that moves into the plasma due to the chloride shift

90
Q

Carbamino Compounds (4)

A

Formed by combination of CO2 with terminal amine groups in blood proteins
Especially globin to give carbamino- haemoglobin
Rapid without enzyme
Reduced Hb can bind more CO2 than oxidised Hb

91
Q

Haldane Effect

A

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

92
Q

Bohr and Haldane effect work in synchrony to

A

Facilitate O2 liberation, CO2 uptake & CO2 generated H+ at tissues

93
Q

Oxygen shifts the CO2 Dissociation Curve to the Left/Right

A

Right

94
Q

The Bohr Effect Facilitates the Removal of O2 from Haemoglobin at Tissue Level by

A

Shifting the O2-Hb Dissociation Curve to the Right

95
Q

Neural control of respiration (2)

A

Mostly medulla oblongata and pons of brain stem are rhythm generators
A network of neurons of the upper medulla called the Pre-Botzinger complex displays pacemaker activity

96
Q

What gives rise to inspiration (5)

A

Rhythm generated by Pre-Botzinger complex
Excites Dorsal respiratory group neurones
Fire in bursts
Firing leads to contraction of inspiratory muscles
When firing stops, passive expiration
occurs

97
Q

What gives rise to active expiration (hyperventilation) (2)

A

Increased firing of dorsal neurones excites a second group

Ventral respiratory group neurones excite internal intercostals and abdominals for forceful expiration

98
Q

Pneumotaxic centre (PC) (4)

A

Located in pons
Terminates inspiration
PC stimulated when dorsal respiratory neurons fire
Without PC, breathing is prolonged inspiratory gasps with brief expiration - Apneusis

99
Q

Apneustic centre (3)

A

Located in pons
Prolongs inspiration
Impulses from these neurones excite inspiratory area of medulla

100
Q

Respiratory centre is influenced by stimuli from (6)

A 
Higher brain centers
Stretch receptors
Juxtapulmonary (J) receptors 
Joint receptors 
Baroreceptors
Central and Peripheral chemoreceptors
101
Q

Higher brain centre examples (3)

A

Cerebral cortex
Limbic system
Hypothalamus

102
Q

Stretch receptors (4)

A

Located in walls of bronchi and bronchioles
Activated during inspiration
Activated only at large (»1 L) tidal volume
Guards against hyperinflation
The Hering-Breur reflex

103
Q

Juxtapulmonary (J) receptors

A

Stimulated by pulmonary capillary congestion, oedema and emboli

104
Q

Joint receptors (2)

A

Impulses from moving limbs reflexly increase breathing

Contribute to the increased ventilation during exercise

105
Q

Baroreceptors

A

Increased ventilatory rate in response to decreased blood pressure

106
Q

Involuntary modifications of breathing (4)

A

Pulmonary Stretch Receptors Hering-Breuer Reflex
Joint Receptors Reflex in Exercise
Stimulation of Respiratory Center by Temperature,
Adrenaline, or Impulses from Cerebral Cortex
Cough Reflex

107
Q

Factors increasing ventilation during exercise (5)

A 
Reflexes originating from body movement
Adrenaline release
Impulses from the cerebral cortex
Increase in body temperature
Accumulation of CO2 and H+ generated by active muscles
108
Q

Cough Reflex (4)

A

Part of defense mechanism from foreign bodies
Activated by irritated or tight airways
Centre in the medulla
Afferent discharge stimulates: short intake of breath, followed by closure of the larynx, then contraction of abdominal muscles (increases intra-alveolar pressure), and finally opening of the larynx and expulsion of air at a high speed

109
Q

Chemical control of respiration (3)

A

Negative feedback control system
Controlled variables are blood gas tensions
Chemoreceptors sense gas tension values

110
Q

Peripheral Chemoreceptors (2)

A

Located in aortic and carotid bodies
Sense tension of oxygen and carbon dioxide
and [H+] in the blood

111
Q

Central Chemoreceptors (2)

A

Situated near surface of medulla

Respond to [H+] of cerebrospinal fluid (CSF)

112
Q

Cerebrospinal fluid (4)

A

Separated from blood by blood brain barrier
Impermeable to H+ and HCO3-
CO2 diffuses readily
Contains less protein than blood so is less buffered

113
Q

Hypercapnia

A

Abnormal build up of CO2 levels in blood

114
Q

Hypoxic drive of respiration (4)

A

Effect mediated via peripheral chemoreceptors
Stimulated when arterial PO2 falls below 8 kPa
Not vital in normal respiration
Vital in high altitudes and patients with chronic CO2 retention

115
Q

Hypoxia at high altitudes is caused by (2)

A

Decreased PiO2

Acute response is hyperventilation & increased cardiac output

116
Q

Chronic adaptation to high altitude hypoxia (5)

A

Increased RBC production - More O2 carrying capacity
Increased 2,3 Biphosphateglycerate - O2 offloaded to tissue more easily
Increased capillary number - More blood diffusion
Increased mitochondria number - O2 used more efficiently
Kidneys conserve acid- Arterial pH decrease

117
Q

H+ drive of respiration (4)

A

Effect mediated by peripheral chemoreceptors
Peripheral receptors play major role in adjusting acidosis caused by addition of non-carbonic acid H+ to blood
Stimulation by H+ causes hyperventilation and increases elimination of CO2 from the body
Vital in acid-base balance

Respiratory (8 decks)

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