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Physiology > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

goblet cells

A

secrete mucous
prostaglandins
heparin (anticoagulant)
histamine

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2
Q

cilia

A

pushes mucous towards pharynx

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3
Q

cystic fibrosis

A

water layer gets too thick

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4
Q

bronchiectasis

A

remodeling and thickening of the walls of the large airways

caused by recurrent infxn

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5
Q

what are some causes of bronchiectasis

A 
cystic fibrosis
AIDS
tuberculosis
chronic bronchitis
primary ciliary dyskinesia
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6
Q

type I cells alveoli

A

for gas exchange

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7
Q

type II cells alveloi

A

sufactant cells

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8
Q

what are the two main factors contributing to inward force of the alveoli

A

elastic recoil

surface tension of water

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9
Q

what usually causes respiratory distress syndrome in neonates

A

lack of surfactant

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10
Q

what are a few things that can cause atelectasis

A

pressure on outside of lungs (fluid build up)
mucus plug blocking airway
lack of surfactant
anesthesia

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11
Q

what is the distance between alveoli and capillary (healthy pt)

A

0.1-1.5 micrometers

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12
Q

how does air move in and out

A

pressure gradient

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13
Q

why does the lung move with the thoracic wall?

A

fluid is the cohesive force and keeps the two pleural membranes together

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14
Q

is the pressure positive or negative in the intrapleural space? why?

A

negative

lungs pull in, chest pulls out, lymphatic system draining fluid

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15
Q

what happens to alveolar pressure during inspiration and expiration

A

inspiration decreases then back to base

expiration increases then back to base

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16
Q

what happens to intrapleural pressure during inspiration and expiration

A

inspiration gets more negative

expiration goes back to base (still negative)

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17
Q

what are the two types of work during breathing

A

compliance work

airway resistance work

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18
Q

what is flow proportional to?

A

change in pressure/ resistance

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19
Q

emphysema causes

A

smoking

alpha 1 antitrypsin (protease inhibitor) deficiency

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20
Q

emphysema DLCO increased or reduced

A

DLCO reduced

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21
Q

pulmonary fibrosis

A

thickened alveolar membrane
stiff lung
caused by increased production of fibroblasts and collagen

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22
Q

pulm fibrosis DLCO increased or reduced

A

reduced

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23
Q

airway resistance

A

determined by length of tubing, viscosity, and radius

Poiseuille’s Law

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24
Q

determining factors for the radius of the respiratory tubes (4)

A 
mechanical connections (connective tissue, alveoli)
physical (mucous)
neural control (ANS)
paracrine and endocrine (CO2, histamine, prostaglandins, WBC)
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25
Q

pulmonary function test

A

help determine obstructive vs restrictive disorder

measures FEV1/FVC

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26
Q

bronchitis

A

inflammation, mucus, infxn, air trapping

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27
Q

asthma mechanism

A

foreign substance
release of IgE
mast cell degrannulation
muscle contraction, mucus

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28
Q

if the FEV1/FVC > 75% but FVC <75% obstructive or restrictive

A

restrictive

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29
Q

FEV1/FVC <75%

A

obstructive

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30
Q

FEV1/FVC > 75% and Normal FVC

A

normal healthy pt

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31
Q

why in a spirometer chart is the exhale peak fast then slow down slope?

A

bc as lung volume decreases the airflow out decreases bc bronchioles collapsed easily by chest pressure

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32
Q

closing volume

A

volume of gas in the lungs in excess of the RV at the time when small airways close

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33
Q

closing capacity

A

closing volume + RV

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34
Q

what increases closing capacity

A

age

smoking

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35
Q

FRC decreases

A

laying down
anesthesia
obesity

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36
Q

FRC < Closing Capacity

A

closing of some airways occurs during TV breathing
V/Q mismatch
alveoli not being V

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37
Q

pulmonary “minute” ventilation

A

RR x TV

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38
Q

physiological deadspace

A

anatomical deadspace + alveolar deadspace

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39
Q

alveolar ventilation

A 
RR x (TV - deadspace volume)
~4.2 L/min
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40
Q

equation for ventilation of alveoli

A

VA(L/min)= VCO2 (ml/min)/PACO2

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41
Q

metabolic acidosis

A

VA decrease

PACO2 increase

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42
Q

metabolic alkalosis

A

VA increase

PACO2 decrease

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43
Q

hypernea (exercise breathing)

A

?

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44
Q

normal blood volume of the lungs

A

450mL (9% of total blood)

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45
Q

mean BP in RV

A

25/ 2 mmHg

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46
Q

mean BP in pulm arteries

A

15mmHg

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47
Q

mean BP in pulm capillaries

A

7-8mmHg

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48
Q

mean BP in pulm veins

A

5mmHg

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49
Q

starlings hypothesis

A

fluid movement due to filtration across the wall of capillary is a balance of hydrostatic P and osmotic P

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50
Q

Capillary fluid movement equation

A

(Pc-Pi) - (Oc- Oi)

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51
Q

Pc

A

capillary pressure

variable depending on pulmonary or systemic

52
Q

Pi

A

variable pulmonary or systemic

53
Q

net positive

A

fluid will move from capillary to interstitial space

54
Q

net negative

A

fluid will move from interstitial space into capillary

55
Q

3 problems leading to pulmonary edema (changes in starling forces)

A

nephrotic syndrome (oc decrease)
pulm capillary membrane damage (oc decrease oi increase)
left heart failure (pc increase)

56
Q

what happens during normal LA pressure increase

A

recruit more capillaries to open to keep pressure low

57
Q

V/Q= 1

A

normal

58
Q

V/Q> 1

A

perfusion low

dead space

59
Q

V/Q< 1

A

ventilation low

pulmonary shunt

60
Q

how does the body compensate for high V/Q

A

bronchoconstriction

61
Q

how does the body compensate for low V/Q

A

vasoconstriction

62
Q

hydrostatic pressure

A

caused by weight of the blood above it in the vessels due to gravity (pressure increases as you go closer to the ground)

63
Q

what is the V/Q ratio for the zone 1 of the lung

A

V/Q>1

64
Q

how can you clinically measure the V/Q of the lungs

A

use xenon and capture with a gamma camera

65
Q

partial pressure

A

pressure of a single gas

66
Q

daltons law

A

total pressure of a mixture of gases is the sum of the pressures of the individual gases

67
Q

henrys law

A

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

68
Q

do equal partial pressures mean equal concentrations of different gases?

A

NO

69
Q

what is atomospheric PO2

A

160mmHg

70
Q

why is the partial pressure of oxygen in the alveoli not equal to the atmospheric partial pressure of oxygen?

A

it is humidified and that reduces the partial pressure

oxygen leaves alveoli constantly

71
Q

water vapor pressure

A

47mmHg

72
Q

tracheal PO2 equation

A

FiO2 * (Patm- PH2O)

73
Q

PAO2 correcting for humidity and oxygen leaving equation

A

[FiO2 * (Patm- PH2O) - (PACO2/RQ)]

74
Q

RQ

A

ratio of total CO2 production to O2 consumption (CO2/O2)

75
Q

sugars (carb diet) RQ

A

1

76
Q

lipids RQ

A

0.7

77
Q

proteins RQ

A

0.8

78
Q

mixed RQ

A

0.8

79
Q

how do the nonalveolar lung tissues get blood flow

A

bronchial artery supplies
azygos vein take some to RV
pulmonary vein take some to LV (shunt)

80
Q

thebesian veins are involved in what

A

anatomical shunt in heart

81
Q

what are the factors that affect oxygenation of tissues (5)?

A 
decrease alveolar PO2
diffusion of oxygen through membrane
gas transport
calc total oxygen carrying capacity CaO2
CO poisoning
82
Q

how do you decrease PO2?

A

go higher in altitude

asthma or other obstructive disease (air trapping)

83
Q

ficks law of diffusion

A

diffusion rate is proportional to:

(change in pressure * SA * diff. coefficient)/membrane thickness

84
Q

examples of problems with diffusion

A 
emphysema (loss of SA)
pulmonary fibrosis (thickening of membrane)
pulm edema (fluid in interstitial space)
85
Q

DLO2

A

diffusing capacity of the lung for O2

86
Q

what is the change in DLO2 when you increase cardiac output (Q)?

A

it decreases because of decreased pulmonary capillary transit time

87
Q 
pick which one is diffusion limited:
nitrous oxide
oxygen
carbon dioxide
carbon monoxide
A

CO

88
Q

what is the purpose of the A-a gradient

A

diagnose the reason for hypoxemia

89
Q

what is the equation for the A-a gradient?

A

[FiO2 *(Patm - PH2O)-(PACO2/0.8)] - PaO2

90
Q

what is a normal A-a gradient

A

10mmHg

91
Q

what are the two ways oxygen can be transported?

A

dissolved in plasma

bound to Hb

92
Q

what happens to the affinity of Hb to oxygen when the CO2 increases?

A

the affinity for oxygen decreases

93
Q

equation for amount of O2 bound to Hb

A

total Hb * 1.34 * SO2

94
Q

anemia

A

decreases Hb and thus decreases CaO2

95
Q

hematocrit

A

ratio of red blood cells to plasma (normal range 40-50)

96
Q

polycythemia

A

increase in RBC and hematocrit/Hb due to blood doping

97
Q

blood doping (2)

A

injection of RBC

use of EPO

98
Q

polycythemia vera

A

bone marrow defect
increase in RBC
slows BF and increases clots
red coloring or blueish tint to areas

99
Q

what does PO2 determine

A

amount of O2 dissolved in plasma

oxygen saturation of Hb

100
Q

PO2 = 60 what is SaO2?

A

90%

101
Q

PO2= 40 what is SaO2

A

75%

102
Q

do ionic interactions that form salt bridges in heme increase or decrease the affinity for O2?

A

decrease

103
Q

bohr effect

A

decrease in O2 affinity of Hb in response to decrease pH due to increased CO2

104
Q

what causes a right shift in the oxyHb curve?

A

acidosis
hypercarbia
hyperthermia
increase DPG

105
Q

how does DPG decrease the affinity of oxygen to Hb

A

by binding the Hb and causing a conformational change

106
Q

carrying capacity equation

A

(total Hb * 1.34 * SO2) + (PaO2 * 0.003)

107
Q

carry capacity units

A

mLO2/dL

108
Q

does CO poisoning shift the curve to the left or the right

A

left

109
Q

what are the three ways that CO2 is carried in the blood?

A

dissolved in plasma (7%)
bound to Hb (23%)
bicarbonate (70%)

110
Q

what is the role of carbonic anhydrase

A

H20+CO2=H2CO2

111
Q

haldane effect

A

as Hb is oxygenated that promotes carbon dioxide dissociation

112
Q

what in the brain stem controls breathing (neuronal control)

A

medulla generates signal

113
Q

dorsal respiratory group DRG

A

normal breathing inspiration

114
Q

ventral respiratory group VRG

A

inspiration and EXPIRATION (mostly ex)

115
Q

what two neuronal signaling centers are in the pons to regulate breathing

A 
pneumotaxic center (slower action pot)
apneustic center (faster action pot)
116
Q

what do both the pneumotaxic and apneustic centers relay their signal to?

A

DRG

117
Q

where do the vagus and glossopharyngeal nerves send afferent info to?

A

DRG

118
Q

what do the central chemoreceptors detect changes in?

A

CO2

and Hydrogen

119
Q

what do the peripheral chemoreceptors detect changes in?

A

O2
(hydrogen and CO2)
aortic and carotid bodies

120
Q

activation of peripheral chemoreceptors

A 
low PO2 binds to protein on glomus cell
inhibits K release
increases Calcium entry
releases Ach
causes action potential on vagus or glosso nerve
121
Q

T/F the body is more sensitive to changes in CO2 and pH than O2

A

true

122
Q

if you are hypercapnic and hypoxic how does that effect the sensitivity of our respiratory changes?

A

additive and more sensitive

123
Q

nociceptors

A

stimulated by particles/gases

elicits bronchoconstriction, cough, tachypnea

124
Q

hering breuer reflex

A

overinflation of the lungs

inhibit inspiration at the DRG (inhibits phrenic nerve)

125
Q

are the peripheral chemoreceptors located on arterial or venous blood supplies? why does this matter?

A

arterial blood
-b/c when exercising the PaO2 will stay high but you are using more O2, how does your body signal to increase RR?? stretch receptors in your muscles

126
Q

can the higher brain control breathing?

A

yes you can change how your breathing by thinking about it

127
Q

what are the two things in the limbic system that help control breathing?

A

hypothalamus

amygdala

Physiology (13 decks)

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