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Physiology > Pulm Deck 1 > Flashcards

Pulm Deck 1 Flashcards

1
Q

4 functions of the respiratory system

A

1) O2 in, CO2 out
2) barrier function
3) metabolic function (angiotensin)
4) host-defense/immune function

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2
Q

what makes up the upper airway? lower?

A
  • nose, pharynx, glottis, vocal cords

- trachea, bronchial tree, alveoli

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3
Q

what is the function of the upper airway?

A
  • to condition air (warm it to body temp) and humidify it

- also provides ~50% of total resistance

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4
Q

at what level of the lung can a piece be removed? what is this called?

A
  • a bronchopulmonary segment= region supplied by 1 segmental bronchi
  • is the anatomic unit of the lung
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5
Q

whats the difference between a pneumothroax and a pleural effusion?

A

pneumothorax- air between visceral (close) and parietal pleura
pleural effusion- fluid

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6
Q

what is the physiological unit?

A
  • respiratory unit=
    respiratory bronchioles, alveolar ducts, and the alveoli - 5 mm tall, but make up a lot of surface area (2.5-3 L) or SA of 50-100m^2
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7
Q

what are conducting airways? what does this form? what is it’s volume?

A
  • bronchi that contain cartilage + non-respiratory (w/o alveoli) bronchioles
  • makes anatomic dead space
  • 150 mL
  • goes up to 16th branch point
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8
Q

what are type 1 and type 2 epithelial cells?

A
  • type 1= very long, 98% surface area, site for gas exchange
  • type 2= produce surfactant
  • exist in a 1:1 ratio in adults
  • neonates don’t have type 2
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9
Q

laplace relationship for lungs

A

inward pressure= 2*surface tension/ radius

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10
Q

what does surfactant do? is there more in smaller or larger alveoli?

A
  • decreases surface tension; more in smaller alveoli
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11
Q

what allows for the stability of alveoli

A
  1. surfactant

2. interdependence- alveoli mechanically linked together

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12
Q

what allows for the interdependence of alveoli?

A
  • collateral ventilation provided by:
    pores of kohn- adjacent alveoli
    channels of lambert- terminal airways- alveoli
    channels of martin- interbronchial
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13
Q

where do bronchial veins come from and where do they go?

A
  • from bronchiole arteries leading to terminal bronchioles

- 1/3 blood goes back to heart, 2/3 drains into pulmonary circulation (admixture)

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14
Q

3 ways inhaled materials are deposited

A

impaction (large in pharynx)
sedementation (medium in small airways)
diffusion (small in alveoli)

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15
Q

what is the mucociliary clearance system?

A
  • removes inhaled particles, consists of:
  • mucus layer
  • pericillary fluid
  • cilia- beat in coordinated fashion, propel stuff up
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16
Q

pathway of lungs

A 
trachea
2 main stem bronchi
lobular bronchi (6 total)
segmental bronchi (bronchopulmonary segment)
bronchioles - non-respiratory 
bronchioles - respiratory 
alveolar ducts
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17
Q

3 ways particles are cleared

A
  • they’re swallowed
  • mucociliary system
  • alveolar macrophages eat them
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18
Q

2 circulation pathways of lung

A
  • bronchial- lungs can survive without

- pulmonary- largest vascular bed in body

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19
Q

where do you lose cilia?
where do you lose smooth muscle?
where do you lose cartilage & mucus glands?

A
  • alveolar ducts
  • alveolar sacs
  • bronchioles
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20
Q

what is Boyle’s law?

A

at a fixed temperature, the volume of gas is inversely proportional to the pressure exerted by the gas

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21
Q

muscles of active expiration

A
  • internal intercostals- flattens ribs and sternum further

- abdominal muscles- causes diaphragm to be pushed further upwards

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22
Q

muscles of inspiration

A
  • external intercostals- ribs go up and out (lateral & anteroposterior)
  • diaphragm- 75% increase in thorax volume- muscle flattens and goes down (vertical)
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23
Q

accessory muscles of inspiration

A
  • SCN
  • scalenus
  • contraction used for forceful inspiration; lift sternum and ribs 1 & 2
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24
Q

what is the diaphragm stimulated by?

A

phrenic nerve (C3-C5)

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25
Q

volumes- tidal, IRV, ERV, Residual

A

Vt- 500 mL (quiet breathing)
IRV- 3,000 mL (volume inhaled past tidal)
ERV- 1,200 mL (volume exhaled past tidal)
RV- 1,200 mL (what’s left)

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26
Q

inspiratory capacity

A

IC= IRV+ Vt= 3.5 L

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27
Q

functional residual capacity

A

FRC= ERV+ RV= 2.4 L

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28
Q

Vital capacity

A

VC= IRV+ Vt+ ERV= 4.6 L

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29
Q

Total lung capacity

A

TLC= IRV + Vt+ ERV+ RV= 5.8 L

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30
Q

which volumes and capacities cannot be measured with a spirometer?

A

RV, FRC, TLC

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31
Q

two ways to measure RV

A

1) helium dilution- requires ventilated tissue

2) body plethysmography

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32
Q

what determines the volume of air in the lungs? what is the equation for specific compliance?

A
  • compliance = change in volume/ change in pressure = 0.2 L/cm H2O
  • specific compliance= lung compliance/lung volume
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33
Q

what is hysteresis?

A

the dissipation of energy between inflating & deflating the lungs

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34
Q

what is the compliance like in emphysema?

A
  • lose elastin
  • high compliance
  • lung easier to inflate
  • low pressure at high volumes
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35
Q

what is the compliance like in fibrosis?

A

decrease compliance b/c of fibrotic tissue; higher pressure at lower volumes

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36
Q

what determines the total compliance of the lungs?

A

lung (elastic pulling it together): chest-wall (muscles pulling out) interactions

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37
Q

atmosphere
intra-alveolar
intra-pleural pressures

A

760 mmHg
760 mmHg
756 mmHg

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38
Q

how do you calculate trans-lung pressure (Pl)?

A

Pl= Pa-Ppl
= 760-756= 4 mmHg
- pressure of lung wall on pleural cavity

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39
Q

how do you calculate transmural pressure (Pw)?

A

Pw= Ppl-Pb
= 756-760 = -4 mmHg
- Pb= pressure on chest wall from air outside
- Pw= difference between pleural cavity and thoracic wall

40
Q

how do you calculate pressure across the respiratory system?

A

Prs= Pl + Pw= 0

41
Q

T/F Intrapleural pressure is always below atmospheric pressure

A

T

42
Q

At points with no air flow, volume is ____ and pleural pressure is _______

A

max, 0

43
Q

3 patterns of gas flow

A

laminar, transitional, turbulent

44
Q

what two things is air flow determined by?

A

pattern of gas flow

resistance to air flow by airways

45
Q

where does laminar flow begin? where is true laminar flow present?

A

smaller airways of the conducting zone; in small bronchioles

46
Q

where is the highest resistance found? why?

A
  • generation 4- medium sized bronchi that are short and branch frequently
  • air flow is turbulent
  • remember air flow at any 1 generation is really parallel
47
Q

3 inspiratory airflow profiles

A

0-9: tubulent, high resistance
10-16: laminar flow, some resistance
17-23: diffusive, respiratory zone, no resistance, independent of respiratory cycle

48
Q

2 things that decrease air way resistance, 4 things that increase it

A
  • decreased by increased lung volume (inhalation), sympathetics
  • increased by vagal stimulation, mucus, edema, contraction of smooth muscle
49
Q

what is the main measure of airway resistance?

A

FEV1- the forced expiratory volume in 1 second

smaller= higher resistance to expiration

50
Q

what is the most important pulmonary function test measurement?

A

FEV1/FVC- greater than 75% are normal, less than 75% are obstructive

51
Q

what happens as lung volume increases?

A
  • force of inspiratory muscles decreases
  • lung recoil pressure increases
  • airway resistance decreases
  • PIFR (peak inspiratory flow rate) is between TLC and RV
52
Q

where does PEFR occur and what happens to it as it approaches resting volume?

A

first 20% of cycle; get expiratory flow limitation

53
Q

what is the effort independent region of flow-volume curve? what is dynamic compression determined by?

A

no matter how strongly you try and exhale, the flow rate always converges the closer to get to the reserve volume; determined by alveolar- pleural pressure

54
Q

when is airflow effort dependent?

A

at higher lung volumes (early expiration)

55
Q

what is flow limitation caused by?

A

the compression of airways when pressure outside is greater than the pressure inside airway

56
Q

what is the equal pressure point?

A

where pressure in the airway is equal to pleural pressure in a region without cartilage

57
Q

which breathing parameter is reduced with obstructive lung disease (asthma, COPD)? Whic is reduced in restricted lung disease (fibrosis)?

A

FEV1- obstructive

FVC- restrictive

58
Q

which receptor does albuterol act on? which parameter does it increase?

A

beta-2 agonist; increases FEV1 and FVC

59
Q

what are the two main components of respiratory work (O2 consumption)?

A
  • elastic work (overcomes elastic recoil)

- resistance work (overcomes airflow resistance)

60
Q

what is elastic work proportional to? flow-resistive work?

A

elastic work- tidal volume

flow-resistive work- frequency of breathing

61
Q

what is the compensation for the increase in work cause by fibrosis? COPD?

A

fibrosis- breathe shallow & rapidly

COPD- breathe slower & deeper

62
Q

what is the ideal gas law?

A

PV=nRT

63
Q

what do Dalton & Amagat’s laws state?

A

Dalton- sum of partial pressures= total pressure

Amagat- sum of partial volumes= total volume

64
Q

what are the partial pressures of O2, N2, and water vapor in humidified air before gas reaches the alveolus?

A 
PO2= 760*0.21= 160 mmHg
PN2= 760*0.79= 600 mmHg
PH2O= 47 mmHg- dilutes other gases!
65
Q

how do you calculate the partial pressure of tracheal O2?

A

(Patm-Ph2O) X Flow of O2= 150 mmHg

(760-47)*0.21

66
Q

what is the alveolar gas equation?

A

Pao2= Pio2- (Paco2/R)

where Pio2= (Patm-Pwater)xFiO2

67
Q

what is the ideal alveolar oxygen amount?

A

102 mmHg

68
Q

what is the respiratory quotient?

A

R= excreted CO2/ O2 taken up

69
Q

what is the fraction of alveolar CO2 determined by?

A

metabolism & rate of ventilation

  • inversely proportional to ventilation
  • a 50% reduction in ventilation will double Pco2
  • directly proportional to production
70
Q

equation for the partial pressure of CO2

A

PCO2= VCO2(production) X (Patm-Ph2o)/alveolar ventilation

71
Q

where is inspired air shunted to? why?

A

lung base

  • base of lung has more alveoli
  • the base is more compliant, can hold more reserve
72
Q

what is a time constant? what does a long time constant mean?

A

the rate at which the alveoli fills
t= resistance x compliance
- longer= slow filling & emptying

73
Q

what happens to the time constant when you increase resistance?

A
  • alveoli fills more slowly & becomes under-ventilated
74
Q

what happens to the time constant when you decrease compliance?

A
  • alveoli fills faster than the normal unit but only receives half the ventilation
75
Q

what are the 4 features of the N2 curve obtained from the nitrogen washout test

A

1) %N2 starts at 0 for some volume as the dead spaces empty
2) rapid upswing in % N2 as alveolar regions empty
3) alveolar plateau where there is equal emptying of all lung zones
4) there is a second upswing due to slowly emptying alveoli

76
Q

what can the nitrogen washout test measure?

A

anatomical dead space- volume in the middle of the first upward inflection

77
Q

what is the equation for ventilation?

A

v= frequency x tidal volume

78
Q

what is physiological dead space and how can it be calculated?

A
  • total volume that does not participate in gas exchange
  • anatomical dead space + alveoli that are ventilated but not perfused
  • measure fraction of expired CO2 and compare it to PaCO2 in blood
79
Q

The larger the tidal volume, the ____ the dead space ventilation; To increase alveolar ventilation, a _______ in tidal volume is more effective than a ______ in the frequency of breathing

A

smaller

80
Q

What is Fick’s law?

A
  • transfer of gas is proportional to the area that it has to go through, a constant, and the difference in partial pressure
  • the transfer of gas is also indirectly proportional to thickness
81
Q

What is Graham’s law?

A
  • the rate of diffusion is direction proportional to the solubility coefficient of the gas
  • inversely proportional to the sqrt of the molecular weight
82
Q

if there is no difference between the partial pressure for a gas in alveoli and end capillary blood, what is flow limited by? what is an example?

A
  • perfusion limited, NO
83
Q

perfusion vs diffusion

A

perfusion- process of delivering blood
vs
diffusion- movement of a substance

84
Q

properties of pulmonary arteries

A
  • carry deoxy blood
  • thin wall, minimal smooth muscle
  • 7X more compliant
  • easily distensible
  • low pressure *** exposed to alveolar pressure
85
Q

3 ways to challenge diffusion of O2

A

1) thicken walls (fibrosis)
2) exercise (decrease time of blood in caps)
3) drop alveolar PO2 in high altitude, gradient drops

86
Q

pulmonary vascular resistance changes with changes in vascular pressure how? and by which mechanisms?

A
  • decreases
    1) recruits more capillaries
    2) capillaries distend to accommodate more blood
87
Q

what is pulmonary vascular resistance?

A

change in pressure between pulmonary artery (14) and left atrium (8) / blood flow ( 6 L/min)
- comes out to 1mmHg/L/min (LOW!!!!)

88
Q

what is PVR regulated by?

A
  • gravity
  • lung volume changing alveolar pressure & extra-alveolar pressure
  • A-V pressure gradient
89
Q

alveolar resistance ___ as you approach total lung capacity, while extra-alveolar resistance ______

A

alveolar- increases (squishing vessels in alveoli)

extra-alveolar- decreases (expanding)

90
Q

when is PVR the least?

A

at the functional residual capacity (stable resting point)

91
Q

two reasons for blood flow to be higher in the base than the apex

A

1) more lung tissue at the base due to shape of lung

2) gravity pulls blood down easier

92
Q

names of 3 zones of the lung

A

zone 1- no-flow zone
zone 2- waterfall zone
zone 3- normal zone

93
Q

what is hypoxic vasoconstriction and what does it depend on?

A
  • if blood is exposed to low PO2 in the alveoli, the vessels constrict
  • depends on the ALVEOLAR concentration of O2, not the blood
  • shifts blood from poorly ventilated areas to well ventilated areas; is important at birth
94
Q

what is fluid movement across capillary governed by? how does edema develop?

A
  • starling forces- hydrostatic & oncotic pressures

- when drainage rate exceeds maximum lymphatic flow

95
Q

excessive filtration from pulmonary capillaries leads to ____, while excessive filtration from systemic capillaries leads to ____

A
  • engorgement of alveolar walls & alveolar flooding

- engorgement of pleural space & pleural effusions (decreased lung volume)

96
Q

what is the difference between obstructive and restrictive lung diseases?

A

obstructive- can’t exhale

restrictive- can’t fully expand

Physiology (22 decks)

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