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Respiration > Physiology of Resp > Flashcards

Physiology of Resp Flashcards

1
Q

what is ventilation/ external resp

A

the mechanical process of exchange of air in atmosphere and of alveoli in lungs

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2
Q

internal resp

A

biochemical reactions

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3
Q

describe inspiration

A

active process

contraction of respiratory muscles

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4
Q

describe expiration

A

passive process

relaxation of respiratory muscles

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5
Q

forces keeping alveoli open

A

surfactant
transmural pressure gradient
Alveolar interdependence

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6
Q

forces keeping alveoli closed

A

Elastic recoil of lungs and chest wall

Alveolar surface tension

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7
Q

what is transmural pressure?

describe the three pressures

A

sub-atmospheric pressure gradient in pleura- keeps alveoli open

atmospheric and intra-alveolar pressures are equal
intrapleural pressure is sub-atmospheric

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8
Q

major inspiratory muscles

A

Diaphragm and external intercostal muscles

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9
Q

accessory muscles of respiration

A

sternocleomastoid
scalenus
pectoral

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10
Q

muscles of active expiration

A

Abdominal muscles

internal intercostal muscle

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11
Q

What is a pneumothorax?

2 methods of how this can occur

A

A build up of air in the intra-pleural space, abolishing the TPG, causing the lung to collapse
Puncture to chest wall or hole in lung

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12
Q

Symptoms and Signs of pneumothorax

A

SOB, pleuritic chest pain
hyper-resonance, reduced chest expansion and chest sounds
small PX can be asymptomatic

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13
Q

Boyle’s Law

A

as the volume of a gas increases, the pressure exerted by that gas decreases

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14
Q

What happens during inspiration

A

Active process
Contraction of diaphragm- phrenic nerve C3,4,5 (increases volume vertically) and external intercostal muscles (increased volume A, P, L)
volume of thorax increases therefore intra-alveolar pressure decreases and air moves in

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15
Q

what happens during expiration

A

passive process
relaxation of diaphragm (dome- vertical volume decreases) and external intercostal muscles (A, P, L)
Elastic recoil of chest and lungs so decreased volume- increased pressure- air moves out

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16
Q

What causes alveolar surface tension

A

H2o molecules lining the alveoli interface

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17
Q
  • Cells that produce surfactant
  • Contents of surfactant
  • Function
A

Type II pneumocytes
lipids and proteins
Reduces alveolar surface tension, preventing collapse

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18
Q

Equation for alveolar pressure

A

P=2T/R

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19
Q

RDS in new born and its treatment

A

Premature baby, born without adequate surfactant, high surface tension, lung collapse
Steroids to mum before birth, synthetic surfactant

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20
Q

Alveolar interdependence

A

one alveoli starts to collapse, neighbouring alveoli stretch and recoil, exerting an expanding force to open the alveoli.

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21
Q

what lung volumes/capacities cannot be measured by spirometry

A

residual volume, functional residual capacity and TLC

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22
Q

tidal volume

A

volume of air entering or leaving lungs during a single breath 0.5L

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23
Q

IRV

A

Extra Volume of air that can be maximally inspired above TV 3.0L

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24
Q

ERV

A

Extra Volume of air that can be maximally expired by maximal contraction after normal TV 1.0L

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25
Q

RV

A

Minimum volume of air remaining in lungs after maximal expiration 1.2L

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26
Q

inspiratory capacity (+equation)

A

IC= IRV+TV 3.5L

Maximum volume of air that can be inspired after normal quiet expiration

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27
Q

FRC

A

FRC=RV+ERV 2.2L

volume of air that remains in lungs after passive expiration

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28
Q

VC

A

VC= IRV+TV+ERV 4.5L

Maximum volume of air that can be expired in a single breath after maximal inspiration

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29
Q

TLC

A

TLC= RV+VC
5.7L
Total volume of air that the lungs can hold

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30
Q

when would RV increase

A

loss of lung elasticity eg emphysema

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31
Q

FVC

A

maximum volume of air forcefully expired from lungs after maximal inspiration

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32
Q

FEV1

A

the volume of air expired in the 1st second of FVC

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33
Q

Normal FEV1/FVC ratio

A

> 0.75

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34
Q
  • Asthmatic FEV1/FVC ratio and why

- what type of lung disease is asthma

A

<0.75
normal FVC, reduced FEV1
asthma is an obstructive lung disease

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35
Q
  • COPD FEV1/FVC ratio and why

- what type of lung disease is COPD

A

<0.7
FEV1 and FVC reduced
COPD is an obstructive lung disease

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36
Q

Reversibility of Asthma and COPD with bronchodilator

A

Asthma shows reversibility with bronchodilator, COPD does not

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37
Q

FEV1/FVC of

a) obstructive
b) restrictive

A

Restrictive- normal ratio, (proportional reduction)

obstructive- reduced ratio

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38
Q

Equation for airway resistance

A

F= change in pressure/resistance

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39
Q

primary determinant of airway resistance

A

radius

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40
Q

effect of parasympathetics and sympathetics on airways

A

p- bronchoconstriction

s- bronchodilation

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41
Q

effect of dynamic airway compression

A

normal person- fine
airway disease-makes active expiration more difficult as airway and alveoli are compressed
obstruction causes fall in airway pressure
made worse by reduced elasticity

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42
Q

what is peak flow meter used to measure
what disease is it used in
how is it used

A

measures peak flow rate
asthma, COPD
short sharp blow, Best of 3

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43
Q

lung compliance

A

measure of unit of change of lung volume per unit of TPG across lung wall
the less compliant the lungs are, more work required to expand lungs

44
Q

causes of reduced lung compliance, symptoms and what type of lung disease pattern?

A

pulmonary fibrosis, oedema, lung collapse, oedema, lack of surfactant
SOB
Restrictive lung disease

45
Q

causes of increased lung compliance

A

Loss of elastic recoil due to aging, emphysema

ie hyperinflation of lungs

46
Q

Fick’s law

A

diffusion of gases across alveolar membrane increases with

  • increased SA
  • decreased thickness
47
Q

what is Diffusion coefficient

compare DC of co2 and o2

A

solubility

co2 twenty times more soluble than o2

48
Q

Daltons Law

A

the total pressure exerted by a gaseous mixture= sum of PP of each component in gas mixture

49
Q

define ventilation and perfusion

A

rate at which air passes through lungs

rate at which blood passes through lungs

50
Q

equation for pulmonary ventilation

A

PV=TV x RR

51
Q

what is alveolar dead space

A

alveoli not adequately perfused with blood

52
Q

what is alveolar dead space

A

ventilated alveoli which are not adequately perfused with blood

53
Q

effect of increased/decreased o2 on pulmonary and systemic capillaries

A

increased 02 -pulmonary vasodilation, systemic vasoconstriction
decreased o2- pulmonary vasoconstriction systemic vasodilation

54
Q

four factors which influence rate of GA across alveoli

A

thickness
SA
diffusion coefficient of 02
PP of 02

55
Q

four factors which influence rate of GA across alveoli

A

thickness
SA
diffusion coefficient of 02 and co2
PP of 02 and co2

56
Q

partial pressure

A

the pressure that one gas in a mixture of gases would exert if it were the only gas in the whole volume occupied by the mixture of gas at a constant temperature

57
Q

what would a large difference between pa02 and PAo2 indicate

A

problems with GE in lungs

left to right shunt

58
Q

which factor of GE has the greatest influence

A

PP of o2 and co2

59
Q

State Henry’s Law

A

the amount of 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

(increased PP of o2 will increase conc of o2 in blood)

60
Q

two mechanisms of o2 transport in the blood and which carries the most o2?

A
  • Haemoglobin (98.5%)

- dissolved (1.5%)

61
Q

how any o2 molecules can each Hb carry?

A

4 02 (4 haem groups)

62
Q

What is the primary factor which determines % saturation of Hb with o2

A

Po2

63
Q

Structure of Hb

A

2 alpha chains
2 beta chains
4 haem groups (Fe2+)

64
Q

factors which determine o2 delivery to tissues

A
  • o2 content of arterial blood

- CO

65
Q

Factors which determine arterial o2 content of blood

A

concentration and saturation of Hb

66
Q

three diseases which impair o2 delivery to tissues

A 
Anaemia (reduced Hb conc)
heart failure (reduced CO)
respiratory disease (reduced p02)
67
Q

Relationship between altitude and PP O2

A

as altitude increases, PPO2 decreases

68
Q

what does PP of inspired o2 depend on

A

atmospheric pressure and proportion of o2 gas (21%)

69
Q

Alveolar gas equation

A

PAO2= Pio2- [paco2/0.8]

70
Q

effect of binding of 1 o2 to Hb

A

increases affinity of Hb for o2

71
Q

explain Bohr curve

A

sigmoid curve-flattens where all sites are occupied
flat upper portions-moderate fall in pao2 wont affect o2 loading
steep lower part- alot of o2 released at peripheries for small drop in pa02

72
Q

What causes a right shift in Bohr curve and consequence

A

increased PaCo2, [H+], Temp, 2,3-bisphosphoglycerate

occurs at tissues - increased release of 02

73
Q

difference in structure between adult and foetal Hb

A

adults Hb- 2 beta units + 2 alpha units

foetal Hb- 2 beta units + 2 gamma units

74
Q

why does foetal Hb have a higher affinity for 02 than adult Hb and effect of this on the o2-Hb dissociation curve?

A
  • HbF has lower affinity for 2,3 Bisphosphoglycerate in RBC

- Curve for Hbf Shifted to left (compared to the right)

75
Q

shape of myoglobin o2 dissociation curve

binding of o2 and myoglobin

A

Hyperbolic

1:1 (1 haem group per myoglobin)

76
Q

where is myoglobin present

A

cardiac and skeletal muscle

77
Q

when is myoglobin released

A

-released at very low p02, short term storage of p2 in anaerobic conditions

78
Q

Three ways in which Co2 is transported in blood and % of each

A
  • solution (10%)
  • bicarbonate (60%)
  • carbamino compounds (30%)
79
Q

what part of haemoglobin does co2 bind to

A

Globin

80
Q

Equation of bicarbonate formation in the body and enzyme required
where does this occur

A

H2O+CO2->H2CO3-> HCO3- + H+
Carbonic anhydrase
occurs in RBC

81
Q

Haw are carbamino compounds formed

A

Co2 combines with terminal amine group in blood proteins

82
Q

State the Haldane effect

A

Removing oxygen from Hb increases ability of Hb to pick up co2 and co2 generated H+

83
Q

how do Bohr effect and Haldane effect work together

A

o2 liberation and CO2 and CO2 generated H+ uptake at tissues

84
Q

what is the major rhythm generator of respiration

A

medulla

85
Q

in which neurons is the rhythm of breathing generated

and location

A

Pre-Botzinger complex

upper end of medullary respiration centre

86
Q

contents of pons respiratory centre

A

pneumotaxic centre

apneuristic centre

87
Q

contents of medullary respiratory centre

A

pre-Botzinger complex

dorsal and ventral respiratory groups

88
Q

What neurons give rise to inspiration

A

dorsal respiratory group

89
Q

what neurons cause forceful inspiration

A

ventral respiratory group

90
Q

what would increased firing from dorsal neurons cause

A

activation of ventral respiratory group

91
Q

what is the rhythm of breathing modified by

A

pons

92
Q 
function of the pneumotaxic centre
what is it stimulated by
A

terminates inspiration

dorsal neurons firing

93
Q

function of apneustic centre

A

excitation of inspiratory area of medulla prolonging inspiration

94
Q

Hering Breur reflex

A

protects against over-inflation

pulmonary stretch receptors

95
Q

Process of cough reflex

A

sharp intake of air
closure of larynx
contraction of abdominal muscle
opening of larynx, expulsion of air

96
Q

Function of chemoreceptor

A

sense blood gas tensions (especially C02)

97
Q

peripheral chemoreceptors and their function

A

carotid bodies
aortic bodies

sense tension of o2,co2 and [H+] in blood

98
Q

Location of central chemoreceptors and what they detect

A

located near the medulla
detect changes in H+ of CSF

co2 diffuses across BB barrier and makes H+

99
Q

what is responsible for hypoxaemic drive and when is this stimulated

A

peripheral chemoreceptors, po2<8KPa

100
Q

target SaO2 in patients with type II respiratory failure

A

88-92%

101
Q

What is hypoxia at high altitudes caused by

A

decreased Pio2

102
Q

acute response to hypoxia at high altitudes

A

hyperventilation and increased CO

103
Q

symptoms of hypoxia at high altitude

A

tachycardia, tachypnoea, confusion, disturbed sleep, collapse, headache, fatigue, nausea, dizziness

104
Q

chronic adaptions to high altitude hypoxia

A 
increased: 
RBC (polycythaemia)
 2,3 BPG in RBC (o2 offload)
Increased capillaries
increased mitochondria
kidneys conserve acid (reduced pH)
105
Q

Describe H+ drive of respiration

A

increased H+ detected by peripheral chemoreceptors causes hyperventilation to blow off co2 (as co2 can make H+)

Respiration (6 decks)

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