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Cardiopulmonary pathology > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

What does conducting zone do?

What are the conducting structures?

A

transport gas btw atmosphere to alveoli; cleanse, warm & humidify air

nose, nasal cavity, sinuses, pharynx, larynx, trachea & bronchioles

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2
Q

What is respiratory zone?

What are the respiratory structures?

A

site of gas exchange

alveoli & lung surrounding alveolar capillary network

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3
Q

air-blood barrier system

This system is seperated by _________

A

consist of thin-wall alveoli epithelium & capillary endothelium

single basement membrane

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4
Q

What does air-blood barrier system do?

A

facilitate the diffusion of oxygen & CO2

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5
Q

ventilation

A

the volume of air breathe in & out in one minute

also refer to the transportation of gas from environment to exchange site

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6
Q

T/F: All air breathe in will reach alveolar surface (gas exchange site)

A

True

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7
Q

Boyle’s law

A

P1V1=P2V2

expansion of gas causes pressure to drop while contraction of space increase the pressure

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8
Q

tidal volume

respiratory rate

A

volume of air in each breathe

the # of breathes in one minute

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9
Q

Minute ventilation (ml/min)

A

respiratory rate (RR) x tidal volume (TD)

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10
Q

anatomic dead space (ADP)

A

the volume of air that reach other destination than alveolar exchange site

1/3 of tidal volume

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11
Q

alveolar ventilation

A

amount of air that reach alveolar surface = RR x (TD- ADP)

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12
Q

what are the factors that affecting the pulmonary ventilation?

A

airway resistance

lung compliance

alveolar surface tension

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13
Q

Formula of air flow (Q)

what factor does air flow depend on largely?

A

Δ P πr4/ 8ηl

radius

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14
Q

why does asthama or bronchitis have higher resistance airflow?

A

because they have small radius of air flow

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15
Q

Infant respiratory distress syndrome (IRSD)

A

deficiency of surfactants in newborn baby -> alveoli diffcult to expand

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16
Q

What can reduce the lung compliance?

What is the consequence of lung compliance?

A

scar formation from chronic inflammation & fibrosis

work of breathing & reduced ventilation

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17
Q

T/F: lung always expand & non-elastic

A

False.

It tends to collapse & elastic -> force to expand

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18
Q

What are ways that the lung can be inflated?

A

positive pressure ventilation: inflated lung via pressure applied to trachea

by sucking lungs against the wall (negative pressure ventilation)

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19
Q

What is the reason for “recoil” tendency of lung?

A

the elastin fiber within alveolar wall & surface tension

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20
Q

Where does surface tension rise from?

A

the electrostatic interaction btw water molecules line on the inner wall of the alveoli

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21
Q

Explain why when there is no air, surface tension increase

A

no air -> intermolecular distance btw water increases -> stronger interactions -> increase surface tension & alveoli tendency to collapse

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22
Q

Where does the surface tension direct toward & create pressure on?

A

center of the lung and on its interior (alveolar)

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23
Q

T/F: small alveoli will require less counter-pressure to prevent them from collapsing

A

False

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24
Q

surfactant

Where is surfactant secreted?

A

mixture of lipid layer that help reduce surface tension

by type II epithelial cells in alveoli

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25
Q

Mechanism of surfactants reducing surface tension

A

reorientating water molecules to themselves -> decrease density of water molecules at air water surface

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26
Q

Compliance curve

A

the non-linear curve of air-inflation reflecting changing elastic recoil properties of lung as function of volume

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27
Q

T/F: inflation curve is the same as deflation curve

A

false. because greater force is required to overcome the surface tension than to keep an open airway from closing

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28
Q

Deflation curve is ______ (linear/ non-linear) curve

A

linear curve

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29
Q

What is the effect of saline on compliance curve of air inflation?

A

compliance curve increase as surface tension is gone

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30
Q

visceral pleural membrane

parietal pleural membrane

A

the mebrane that covers each lung (green box)

inner wall of the chest (purple box)

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31
Q

intrapleural fluid

what is the benefit of this fluid?

A

the fluid secreted by the visceral & parietal pleural membrane

hold the lung inflated against the chest inner wall

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32
Q

What does intrapleural fluid give to?

Identify intrapleural fluid

A

intrapleural pressure (756 mmHg)

yellow box

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33
Q

intrapulmonary pressure

transpulmonary pressure

Identify each in this picture

A

the amount of pressure maintained inside the lung (red box)

the difference of intrapulmonary repssure and intrapleural pressure (brown box)

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34
Q

At rest (no air), what force that oppose elastic recoil of chest?

A

the positve transpulmonary pressure & the negative intrapleural pressure

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35
Q

During inspiration, Patm is ____ (greater/less) than Pavl

During expiration, Patm is ____ (greater/less) than Pavl

A

greater

less

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36
Q

What are the two factors that volume of lung depend on?

A

lung compliance & transpulmonary pressure

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37
Q

Describe the sequence of events during inspiration

A

1) diaphragm descend inferiorly; ribs are elevated & sternum flares as external costal contract
2) thoracic cavity volume increase
3) intrapleural volume increases -> its pressure become more negative (-6mmHg)
4) lung expands & intrapulmonary pressure more negative (-1mmHg)
5) transpulmonary pressure more positive ( 5mmHg)
6) air flows in down its pressure concentration gradient until intrapulmonary pressure is equal to atmospheric pressure

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38
Q

Describe the subsequent events of expiration

A

1) diaphragm rises while ribs & sternum descends as external intercostal contract
2) thoracic volume decreases
3) elastic lungs recoil passively -> alveoli gas is compressed (volume decrease)
4) intrapulmonary pressure increase by 2 mmHg (from -1 mmHg -> 1 mmHg)
4) Palv>Patm
5) air flows out the lung

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39
Q

During excercise, what are accessory muscles that are required?

A

sternocleidomastoids

scalene

serratus

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40
Q

During exercise expiration, what is activated?

A

contraction of internal intercostals, which squeeze ribs together & abdominal push upward against diaphragm

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41
Q

inspired reserve volume (IRV)

residue volume (RV)

A

amount of air that is forcibly inspired beyond tidal volume

the volume of air that remains in lung to keep alveoli inflated

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42
Q

T/F: the value of IRV is equal to the ERV (expired reserve volume)?

A

False

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43
Q

Vital capacity (VC)

A

the maximal amount of air that can be expired after maximum inhalation

TV + ERV + IRV

44
Q

inspiratory reserve volume (IRV)

A

the maximal volume of gas that can inspired in excess of tidal inspiration

45
Q

inspiratory capacity

A

the maximal volume of gas can be inspired into the lung after tidal expiration

TV + IRV

46
Q

functional residual capacity

A

the amount of air remaining the the lungs after a normal tidal expiration

RV + ERV

47
Q

residue volume

A

the amount of air remaining in the lungs after maximum expiration to keep alveoli inflated

48
Q

expiratory reserve volume (ERV)

A

the maximal amount of air that can be expired in excess of tidal expiration

49
Q

T/F: Intrapleural pressure value is always negative

A

True

50
Q

At the end of expiration/ inspiration, how is the value of intrapulmonary pressure compared to atmospheric pressure?

A

they are equal to 0 because there is no air flow

51
Q

T/F: the value of intrapleural pressure in the end of expiration is greater than in the end of inspiration?

Explain??

A

True

-4mmHg in end of expiration > -7 mmHg in inspiration

Volume of lung decreases when it near reaches end of expiration while volume increases when it near reaches end of inspiration (Boyle’s law)

52
Q

pulmonary arteries

A

the blood vessels carry deoxygenated blood & feed the extensive capillary network surrounding alveoli

53
Q

pulmonary circulation

systemic circulation

A

the process of transport deoxygenated from the heart to lungs & return with oxygenated blood to heart

the cardiovascular system that deliver oxygenated blood throughout body

54
Q

What are the difference btw pulmonary arteries & systemic arteries?

A

pulmonary arteries have larger diameters, less smooth muscle than systemic arteries

55
Q

T/F: pulmonary arteries receives the entire cardiac output

A

True

56
Q

Pulmonary arteries has _____ (high/low) flow, ______ (high/low) pressure system due to ______ (high/low) resistance vessels?

A

high

low

low

57
Q

What happen to the pulmonary resistance value when pulmonary pressure increase?

A

resistance falls even lower because previous closed blood vessels open up (recruitment) & individual capillary segments increases their radii (distension)

58
Q

hypoxia

A

a condition in which part of body is deprived of adequate oxygen supply (PO2<60 mmHg)

refer to as insufficient oxygen in blood due to the inadequate ventilation

59
Q

hypoxemia

A

condition in which there is a decrease of flow of oxygenated blood vessels

60
Q

What is the mechanism to compensate hypoxia?

A

diverting flow from poorly ventilated alveoli to those that are receiving more oxygen & thus optimize pulmonary gas exchange

by constriction of arterial smooth muscle in hypoxic area

61
Q

T/F: the resistance rises when pulmonary arteries pressure inrease

A

False.

Resistance fall even lower

62
Q

Henry’s law

A

amount of gas dissolved in fluid will be proportional to the gas partial pressure

Ex: the higher gas partial pressure -> higher gas dissolution

63
Q

How is the mechanism that respond to hypoxia of pulmonary circulation different from systemic circulation?

A

In systemic circulation, blood vessel dilate to increase flow to area

In pulmonary circulation, blood vessel constrict

64
Q

What are factors that affect movement of oxygen from alveoli to blood & of CO2 in opposite direction?

A

partial pressure

ventilation- perfusion coupling

surface areas of gas diffusion & permeability of respiratory membrane (wall thickness)

65
Q

Value of alveolar oxygen partial pressure

Value of blood capillaries oxygen partial pressure

A

104 mmHg

40 mmHg

66
Q

Value of alveolar CO2 partial pressure

Value of blood capillaries CO2​ partial pressure

A

39 mmHg

46 mmHg

67
Q

What factor compromise the small difference of partial pressure gradients of CO2to result in the same amount of CO2 leaving the blood as oxygen entering?

A

20-fold greater solubility of CO2 than oxygen

68
Q

Solubility coefficient of oxygen (Ksp O2) = ????

A

0.003 ml O2/ dl/mmHg

69
Q

How does the high lvl of CO2 partial pressure in alveoli synchronize the ventilation-perfusion coupling?

A

high lvl of CO2 -> dilation of bronchioles -> allowing CO2 released in the atmosphere more easily

70
Q

What does the gas exchange at capillary-tissue surface mainly depend on?

A

partial pressure gradient

71
Q

T/F: alveolar oxygen pressure is equal to arterial oxygen pressure after equilibrium

A

False.

they are not equal. there is slight difference (4mmHg) btw PAO2 & PaO2

72
Q

What contributes to the small difference btw alveolar oxygen pressure & arterial oxygen pressure?

A

imperfect balance btw ventilation & perfusion of the lung

small contribution of deoxygenated blood arise from bronchiole circulation

73
Q

What contribute to the alveolar-arterial oxygen difference?

A

age & the loss of lung compliance

74
Q

T/F: the partial pressure oxygen of arterial blood is lower because the amount of oxygen constantly diffuses to the cells

A

False.

Although O2 is constantly diffusing to the cells, it is consumed in cell respiration so that the PO2 remain constant

75
Q

What does abnormal high alveolar-arterial oxygen difference tell us?

A

pathological problem in gas exchange: asthma, emphysema, pneumonia

76
Q

T/F: thre is large % of oxygen is carried in the blood through dissolvation

A

False

Only 1.5% of oxygen is carried in blood through dissolvation

77
Q

Calculation of amount of oxygen released from alveoli to blood

A

104 x 0.003 - 40x 0.003= 0.19 ml O2/dl/mmHg

78
Q

Explain the process of CO2 travel as bicarbonate ion & expelled out of the lung?

A

1) CO2 travel through plasma into RBC to convert into bicarbonate ion
2) bicarbonate ion diffuse back to plasma & converted back to CO2 to be expelled from lung

79
Q

the value of solubility coefficient of CO2

A

0.06 ml/dl/mmHg

80
Q

What are ways to carry CO2?

A

dissolved in tissue plasma (7-10%)

as bicarbonate ion (70%)

bound to Hb (20%)

81
Q

Haldane effect

A

the oxygenation of blood is enhanced by the dissocation of CO2 from Hb while the loss of O2 to tissue facilitate the uptake of CO2

82
Q

Increase temperature, acidity & BPG will _____ (increase/decrease) affinity of Hb to oxygen

Shift the curve to _____ (left/right)

A

decrease

right

83
Q

Why do we say Hb express the cooperative curve?

A

because each binding oxygen to Hb will cause the structural change in Hb -> increase affinity to oxygen

84
Q

T/F: Hb irriversibly binds to oxygen molecules

A

False.

reversible

85
Q

How to calculate the amount of oxygen released into the tissue?

A

by calculating the difference of the amount of oxygen carried by Hb in alveoli & in tissue

In alveoli: 1.34ml O2 / g of Hb x 15 g of Hb/ dl = 20.1 ml/dl (100% Hb saturation)

In tissue: 1.34ml O2 / g of Hb x 0.75 x15 g of Hb/ dl= 15.08 ml/dl (75% Hb saturation)

5 ml O2/ dl is released to tissue

86
Q

How is the electron neutrality is maintain in RBC when there is outflow of bicarbonate ion(-) ?

A

there will be inward diffusion of one Cl-

87
Q

How many oxygen molecules can a Hb carry? Why?

A

4

because there are 4 iron-heme groups in 4 polypeptide chains

88
Q

What will buffer H+ ?

A

plasma protein in plasma & Hb in RBC

89
Q

T/F: when CO2 bind to Hb, it competes with oxygen by the binding site

A

False

CO2 bind directly to the N-terminal amino groups & to lysine side chain of Hb

90
Q

In an ideal lung, what is the value for optimal exchange gas btw lung & capillaries?

A

4.2(V) / 5(Q) = 0.84

91
Q

In non-ideal lung, how does the ventilation & perfusion varies?

A

both V & Q increase from apex to the base of the lungs but not at equal rate

92
Q

Explain why at the apex of the lung, ventilation is lower in apex than in base?

A

intrapleural pressure is less negative (increase) at the bottom of the lung -> transpulmonary pressure is less than at bottom -> alveoli less distend & receive more gas for each inspiration

93
Q

What is the bad side of alveoli distension in the apex?

A

they will lose their compliance -> receive less ventilation

94
Q

Explain why the perfusion of the apex is less than at base?

A

because at the apex, alveolar pressure is greater than pulmonary arterioles & venules -> crushing the alveolar capillaries -> minimal flow

95
Q

How does the V/Q ratio is different at top from the bottom?

A

its larger at the top (3) than the bottom (0.6)

96
Q

What does abnormal low V/Q indicate?

A

increased perfusion (Q) while V at fixed or there is block in alveoli

-> the ventilation is not keeping pace with perfusion -> lower partial pressure of O2 in arterioles & increase of CO2

97
Q

T/F: In non-ideal lung, both V & Q increases from apex to base at equal rate?

A

False

at unequal rate

98
Q

What does abnormal high V/Q indicate?

A

impairment of pulmonary blood flow -> lower Q ->

99
Q

When V/Q is increase infinitively, what does it indicate?

A

there is complete block in pulmonary arteries -> Q= 0

100
Q

What are the consequences of partial block in arterioles (low Q -> high V/Q)?

A

the blocked blood will reroute to other alveoli -> Q of other alveoli increase -> V/Q decreases -> lower alveolar oxygen partial pressure & high alveolar CO2 pressure

101
Q

What is the consequence of complete block pulmonary arterioles?

A

affected alveoli will become anatomical dead space, exchange air with atmosphere but not with blood -> wasted ventilation

102
Q

What is the mechanism to compensate the block in pulmonary arteries to maintain ventilation-perfusion ratio?

A

constricting the airway of alveoli at blocked arteries

-> increasing alveolar oxygen partial pressure in the unaffected alveoli with over-perfused blood flow

103
Q

when there is a complete block in alveoli, what is the value of end-capillary blood will be?

A

it is the mixed venous blood of non-affected & affected alveoli flow

104
Q

what mechanism compensate the low V/Q?

A

hypoxic vasoconstriction

105
Q

hypoxic vasoconstriction

A

the blood flow through the alveoli that has blockage will decrease to increase the blood flow on the unaffected alveoli

106
Q

How do you check if a person has a complete block in alveoli?

A

give 100% oxygen to breathe the total amount dissolved oxygen will not increase dramatically as in case without block

107
Q

T/F: end-capillary blood from shunted alveoli will mix with blood from normal alveoli resulting in decrease in alveolar oxygen partial pressure

A

Cardiopulmonary pathology (12 decks)

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