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Pulmonary Flashcards

1
Q

Most important muscles that raise the rib cage to facilitate inspiration

A

Diaphragm 75%

1 external intercostals
2 SCM
3 anterior serratus
4 scalenes

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2
Q

Muscles that pull ribs downward during expiration

A

1 abdominal recti
2 internal intercostals

Elastic recoil of lung, chest wall and abdominal structures

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3
Q

Pressure of fluid in thin space bet lung pleura and chest wall pleura

A

Pleural pressure

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4
Q

Pleural pressure is

A

slightly negative -5 cmH20 beginning inspiration

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5
Q

Normal inspiration creates a more

A

negative pleural pressure from -5 to -7.5

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6
Q

Pressure of air inside the lung alveoli

A

Alveolar pressure 0cm when glottis is open and no airflow

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7
Q

During inspiration, to cause inward flow alveolar pressure must

A

fall to slightly below atm pressure at -1cmH20

During expiration, alveolar pressure rises to +1cmH2O

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8
Q

Difference between pleural and alveolar pressure; measure of elastic force in lungs that tend to collapse lungs at each instant of respiration

A

Transpulmonary pressure

Recoil pressure

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9
Q

Extent to which lungs will expand for each unit increase in transpulmonary pressure

A

Compliance

Everytime the transpulmo pressure increases by 1cm H2O the lung volume after 10-20 sec will expand by 200mL

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10
Q

Compliance is determined by

A

1 elastic forces of lung tissue

2 elastic forces by surface tension of fluid lining inside walls of alveoli and other lung air space

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11
Q

Elastin forces of lung are determined by

A

elastin and collagen

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12
Q

Surface active agent in water greatly reducing surface tension of alveoli and subsequently, decrease the work of breathing

Complex phospholipid secreted by Type II epithelial cell

A

Surfactant

Produced in terminal saccular stage

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13
Q

Tendency of water molecules on surface to contract via their strong attraction for one another such as in raindrop

In alveoli, it attempts to force air out of alveoli through bronchi leading to alveolar collapse

Created by attractive forces between water molecules producing collapsed alveoli

A

Surface tension

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14
Q

Surfactants are secreted by

A

type II alveolar epithelial cells

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15
Q

Most important components of surfactant

A

1 dipalmitoylphosphatidylcholine

2 Ca ion

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16
Q

Blocking the passages leading to alveoli lead to

A

Inc surface tension and collapse creating positive pressure attempting to push the air out

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17
Q

Pressure from blocked alveoli attempting to push air out =

A

Pressure = (2xsurface tension)/radius of alveolus

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18
Q

Reducing alveolar surface tension

A

Reduces effort required by muscles to expand lungs

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19
Q

Pressure is inversely proportional to

A

radius of alveoli

hence in small babies, tendency to collapse is much greater due to greater pressure, smaller radius and lack of surfactant

Law of Laplace

Collapsing pressure = 2 x surface tension/aveolar radius

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20
Q

Inspiration 3 fractions

Work of breathing

A

1 compliance work / elastic work - req to expand the lungs against lung and chest elastic forces
2 tissue resistance work - req to overcome viscosity of lung and chest wall
3 airway resistance work - req to overcome airway resistance to movement of air into lungs

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21
Q

Volume of air inspired or expired with each normal breath amounting to about 500mL in adult male

A

Tidal volume

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22
Q

Extra volume of air that can be inspired over and above normal tidal volume when the person inspires with full force

Equal to about 3000 mL

A

Inspiratory reserve volume

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23
Q

Maximum extra volume of air that can be expired by forceful expiration after end of a normal tidal expiration

Amounts to 1100 mL

A

Expiratory reserve volume

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24
Q

Volume of air remaining in lungs after most forceful expiration

Averages about 1200 mL

A

Residual volume

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25
Q

Total Lung Capacity =

A

TLC = IRV + TV + ERV + RV

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26
Q

Pulmonary volumes

A

1 TV
2 IRV
3 ERV
4 RV

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27
Q

Pulmonary capacities

A

1 Inspiratory capacity
2 functional residual capacity
3 vital capacity
4 total lung capacity

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28
Q

Amount of air a person can breathe un beginning at normal expiratory level and distending lungs to maximum amount

IRV + TV

A

Inspiratory capacity

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29
Q

Amount of air that remains in lungs at the end of normal expiration 2300 mL

ERV + RV

A

Functional residual capacity

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30
Q

Maximum amount of air a person can expel from lungs after first filling the lungs to maximum extent and then expiring to maximum extent 4600mL

IRV + TV + ERV

A

Vital capacity

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31
Q

Maximum volume to which lungs can be expanded with the greatest possible effort 5800mL

VC (TV+IRV+ERV) + RV

A

Total lung capacity

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32
Q

RV =

A

RV = FRC - ERV

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33
Q

TLC =

A

TLC = FRC + IC

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34
Q

Lung volumes and capacities directly measured by spirometry

A

FRC
ERV
IC
TLC

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35
Q

Total amount of new air moved into respiratory passages each minute

TV x RRperminute

A

Minute respiratory volume
Minute ventilation

Ave 6L/min

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36
Q

Air that fills passages where gas exchange does not occur

Portions of the lungs that are ventilated but in which no gas exchange occurs

A

Dead air space

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37
Q

All space of respiratory system other than alveoli and closely related gas exchange areas

Volume of conducting airways not involved in gas exchange

150mL

A

Anatomic dead space

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38
Q

When not only the anatomic dead space is taken into account but also the nonfunctional alveoli

Sum of the anatomic and alveolar dead spaces

A

Physiologic dead space

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39
Q

Total volume of new air entering alveoli and adjacent gas exchange areas each minute

Ventilated alveoli that are not perfused

Negligible amount

A

Alveolar ventilation per minute

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40
Q

Alveolar ventilation =

A

VA = freq x (VT - VD)

Freq respiration per minute
VT tidal volume
VD physiologic deadspace

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41
Q

The greatest amount of resistance to airflow occurs through

A

passages of larger bronchioles and bronchi near trachea

bec these are relatively few in comparison with the approximately 66k parallel terminal bronchioles with only minute amount of air must pass

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42
Q

Substances that cause bronchiolar constriction by mast cell

A

Histamine

Slow reactive substance of anaphylaxis

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43
Q

Cilia beats continually and the direction of their power stroke is always toward

A

the pharynx

beat upward

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44
Q

Cilia in the lungs

A

beat upward

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45
Q

Cilia in the nose

A

Beat downward

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46
Q

Nasal cavity function

A

Warming
Humidifying
Filtering

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47
Q

Removal of particles by air hitting many obstructing vabes (conchae, septum, turbulence)

A

turbulent precipitation

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48
Q

Two circulations of the lungs

A

1 high pressure-low flow - systemic blood to trachea, bronchial, terminal bronchiole
2 low pressure-high flow - venous blood from body to alveolar capillary

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49
Q

Pulmonary artery has

A

Large compliance 7ml/min bec of large diameter and thin distensible vessel

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50
Q

Bronchial artery empties directly into

A

Pulmonary veins and left atrium rather than back to the right atrium making flow of L side of heart 1-2% greater

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51
Q

Systolic pulmo arterial pressure

Diastolic pulmo arterial pressure

Mean pulmonary arterial pressure

A

25mmHg

8mmHg

15mmHg

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52
Q

Left atrial pressure is estimated using

A

Pulmonary wedge pressure

Cath in pulmonary artery with direct connection to pulmonary capillary

5mmHg but bec of direct connection only 2-3mmHg greater than left atrial pressure

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53
Q

In response to a dec in oxygen in air alveolar (below 70%) the adjacent blood vessels

A

constrict
vascular resistance inc 5x at extremely low O2 level

believed to be due to a vasocon secreted by alveolar epithelial cell

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54
Q

In systemic vessels, a low oxygen concentration will promote

A

vasodilation

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55
Q

Vasoconstriction in pulmo vessels is important bec

A

poor ventilation will drive blood flow to be shunted to areas that are better aerated for maximal gas exchange

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56
Q

Zone 1 of lungs

A

No blood flow during all portions of cardiac cycle (collapsed)
Alveolar air pressure greater than arterial pressure

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57
Q

Zone 2

A

Intermittent flow during peaks of pulmonary arterial pressure
Systolic arterial pressure rises higher than alveolar air pressure (blood flow) 10cm above midlevel of heart
Diastolic arterial pressure falls below alveolar air pressure

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58
Q

Zone 3

A

Continuous flow

Arterial pressure and pulmonary capillary pressure greater than alveolar air pressure all the time

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59
Q

During supine, blood flow is entirely on

A

zone 3

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60
Q

Zone 1 no blood flow occurs in abnormal conditions such as

A

Upright person breathing against positive air pressure

Low pulmo systolic arterial pressure in severe blood loss

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61
Q

During exercise, pulmonary vasculature pressure rises enough

A

converts lung apices from zone 2 to 3 pattern

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62
Q

During heavy exercise, blood flow through lungs increase but accomodated by

A

1 inc no. of open capillaries
2 distending capillaries and inc rate of flow through each capillary
3 inc pulmonary arterial pressure

First two, dec vascular resistance

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63
Q

Inc blood flow in lungs during exercises without increasing pulmonary arterial pressure conserves energy of

A

rigt side of the heart

prevents significant rise of PCP preventing edema

64
Q

Alveoli are kept dry bec

A

There is a slight negative pressure in interstitial spaces that keeps it dry sucking mechanically into the interstitium

65
Q

Pulmonary edema develops bec

A

1 inc fluid filtration out of pulmonary capillary
2 impedance in pulmonary lymphatic function causing interstitial fluid pressure to rise from negative (sucking) to positive

Inc in left atrial pressure (LSHF & mitral valve disease) -> Inc pulmonary venous and pulmonary capillary pressure

66
Q

Acute safety factor against pulmonary edema

A

21 mmHg pulmonary capillary pressure

7 - 28 mmHg

Greatly adapted to safety factor in chronic conditions such as mitral valve stenosis bec of lymphatic accomodation

67
Q

To keep the lungs expanded,

A

a negative force is always required on the outside of the lungs by negative pressure in pleural space

-4mm but actually -7mmHg

68
Q

Pleural effusion caused by

A

1 blockage of lymphatic drainage from pleural cavity
2 cardiac failure causing excessive peripheral and pulmonary capillary pressure, excessive transudation of fluid into pleural cavity
3 greatly reduced plasma colloid osmotic pressure
4 infection

69
Q

Gas pressure =

A

directly proportional to the concentration of gas molecules and the solubility coefficient

70
Q

The rate of diffusion of the gasses in the system is directly proportional to the pressure caused by that gas alone.

A

Partial pressure

71
Q

Henry’s law

A

Partial pressure = concentration of dissolved gas / solubility coefficient

72
Q

Partial pressure that water molecules exert to escape through surface

A

Vapor pressure of water

At body temp, 47mmHg

73
Q

Factors that determine rapidity of diffusion

A

1 thickness of membrane (pulmo edema, fibrosis)
2 surface area of membrane (emphysema, removal of a lung segment)
3 diffusion coefficient
4 partial pressure difference of gas

74
Q

Volume of gas that will diffuse through membrane each minute for a partial pressure difference of 1

A

Respiratory membrane diffusing capacity

75
Q

In lung areas with 0 V/Q, the partial pressure of gasses in the alveoli

A

equals that of the venous blood

PO2 40mmHg
PCO2 45mmHg

76
Q

When V/Q equals infinity, the alveolar partial pressure is

A

equal to humidified inspired air bec there is no capillary bf to carry O2 and CO2 to alveoli

PO2 149mmHg
PCO2 0mmHg

77
Q

Whenever V/Q is below normal and a fraction of venous blood passing through the capillary does not become oxygenated there is

A

shunted blood

78
Q

When V/Q is greater and far more available oxygen in the alveoli can be transported away from alveoli by flowing blood, ventilation is said to be

Anatomic dead space + areas of poor flow but excellent ventilation

A

wasted

Physiologic dead space

79
Q

At the top of the lung,

A

physiologic dead space

V/Q is 2.5 x as great as the ideal value

80
Q

In the bottom of the lung,

A

Physiologic shunt

Too little ventilation with V/Q as low as 0.6 times ideal

81
Q

A high PO2 in the capillary promotes

A

oxygen binding with hemoglobin

and vice versa

82
Q

Factors that shift O2 dissociation curve to the right

A

1 inc CO2
2 inc blood temp
3 inc 2-3 bisphosphoglycerate (hypoxia)
4 dec pH

83
Q

Inc in blood carbon dioxide and H ions enhance release of oxygen from blood to tissues

A

Bohr effect

84
Q

Inspiration

A

Diaphragmatic contraction
External intercostal contraction
Internal intercostal relaxation
Increased AP diameter

85
Q

Abdomen is sucked in while accessory muscles of inspiration are contracting

Indicator of impending respiratory failure

Flail chest

A

Paradoxical breathing

86
Q

Inflow and outflow of air between the atmosphere and lung alveoli

A

Pulmonary ventilation

87
Q

Lung distensibility

Compliant lungs are easy to distend

A

Compliance

Normal = 200 ml/cmH20

88
Q

Resits deformation

E= delta P/ delta V

89
Q

Increased compliance

Reduced elastance

A

Obstructive lung disease

90
Q

Increased elastance

Reduced compliance in lung fibrosis

A

Restrictive lung disease

91
Q

In conditions like pulmonary fibrosis
alveolar edema
atelectasis

Increased surface tension, the compliance work is

A

reduced because the fibrotic tissue requires more work to expand

92
Q

What type of cells secrete surfactant?

A

Type II Pneumocyte

93
Q

Type II pneumocyte histology

A

Cuboidal epithelial

94
Q

Surfactant

A

Dipalmitoylphosphatidylcholine

Dipalmitoylecithin

95
Q

States that collapsing pressure is inversely proportional to the alveolar radius, such that smaller alveoli experience a larger collapsing pressure

A

Laplace’s law

Ex: smaller alveoli in preterm babies -> dec surfactant/inc surface tension-> larger collapsing pressure in <34 weeks -> NRD

96
Q

Work required to overcome resistance in the conducting airways

A

Airway resistance 20%

97
Q

Work required to expand the lungs against the lung and chest elastic forces

A

Compliance/Resistance 75%

98
Q

Work required to overcome the viscosity of the lung and chest wall structures

A

Tissue resistance

99
Q

Airflow resistance =

Poiseuille’s Equation

A

Airflow resistance = (air viscosity x airway length)/ airway radius

100
Q

Reduction of airway diameter (smooth muscle contraction, excess secretion) airway resistance is

A

increased

Obstructive LD

101
Q

Combinations of two or more pulmonary volumes

A

Pulmonary capacities

102
Q

In restrictive disease, lung volumes are

103
Q

In obstructive LD, lung volumes are

104
Q

Air trapping in COPD

A

Inc RV
Inc AP diameter
Barrel-chested

105
Q

Total lung capacity is the

A

Maximum lung volume

106
Q

Total lung capacity in obstructive disease

107
Q

TLC in restrictive lung disease

108
Q

Maximum amount of air that can be exhaled in 1 second after a maximal inspiration

Constitutes about 80% of FVC

109
Q

FEV1/FVC =

110
Q

FEV1/FVC ratio in obstructive lung disease

111
Q

FEV1/FVC ratio in restrictive lung disease

A

Normal/increased

112
Q

Reversibility is demonstrated if

A

> 12%
200 ml increase in FEV1

15 mins after an inhaled beta 2 agonist

Or 2-4 week trial or oral corticosteroids (Prednisolone or Prednisone 30-40mg daily)

113
Q

Minute Ventilation =

A

Minute Ventilation = Respiratory rate x Tidal volume

12bpm x 500 ml = 6L/min

114
Q

RR x (TV - Dead Space)

12 bpm x (500ml - 150ml) = 4.2L/min

Rate at which new air reaches the gas exchange areas

A

Alveolar ventilation

115
Q

Increases during mechanical ventilation

A

Anatomic dead space

116
Q

Basic control of respiratory rhythm originates from the

A

Dorsal and ventral respiratory groups located within the medulla

117
Q

Located along entire length of the dorsal medulla

Controls basic rhythm of respiration

Accomplished by neurons that spontaneously generate action potentials (similar to the sinoatrial node) which stimulate inspiratory muscles.

A

Dorsal respiratory group

118
Q

Located on ventral aspect of the medulla

Stimulates expiratory muscles as in forced expiration

Muscles which are inactive during normal quiet respiration because expiration is a passive process under normal condition, become important only when ventilation is high (eg. with exercise)

A

Ventral respiratory group

119
Q

Fine control of respiratory rhythm originates from the

A

Pneumotaxic

Apneustic center of pons

120
Q

Located in superior pons, its neurons project to the dorsal respiratory group

Inhibits inspiration
Limiting the size of tidal volume, and secondarily increasing the breathing rate

A

Pneumotaxic center

121
Q

Located in the inferior pons, it projects to the dorsal respiratory group

Increases the duration of respiratory signals, increasing duration of diaphragmatic contraction resulting in more complete lung filling and a decreased breathing rate

A

Apneustic center

122
Q

Inhibits inspiration
Dec lung filling
Inc RR

A

Pneumotaxic

123
Q

Increased duration of inspiration
Inc lung filling
Dec RR

124
Q

Lung over inflation

DRG takes over

Switches off inspiration
Tidal volume 3x normal (>1.5L)

A

Hering-Breuer Inflation Reflex

125
Q

Control by higher brain centers can

A

override basic controls of brainstem

126
Q

Chemical control of breathing

A

Co2 (central)
H (central)
O2 (peripheral) carotid bodies, aortic bodies

127
Q

Carotid bodies
Aortic bodies

Respond to changes in the arterial blood

Stimulated by:

A

Peripheral chemoreceptors

Decreased PO2
Increased H ion concentration

128
Q

Located in the medulla oblongata

Respond to changes in the brain’s extracellular fluid

Stimulated by increased

A

Central chemoreceptor

PCO2 related to H concentration

129
Q

Blood pCO2 changes have potent

A

Acute effect

But weak chronic effect after few days because renal takes over

130
Q

Transport of CO2 in the blood:

A

1 Transport in the form of bicarbonate ions (70%)

2 Transport in combination with hemoglobin (carbaminohemoglobin) (23%)

3 Transport in the dissolved state (7%)

131
Q

Inside RBC, CO2 reacts with water to form carbonic acid
Reaction is catalyzed by carbonic anhydrase

Most carbonic acid dissociates into bicarbobate ions and hydrogen ions

Bicarb ions diffuse from RBC into plasma & chloride ions diffuse into RBC to take their place, phenomenon is called chloride shift

Hydrogen ions on the other hand combine with hemoglobin

A

Transport in the form of bicarbonate ions (70%)

132
Q

An enzyme found in RBCs, gastric mucosa, pancreatic cells and renal tubules

Catalyzes the interconversion of carbon dioxide CO2 and carbonic acid H2CO3

A

Carbonic anhydrase

133
Q

Oxygen from the lungs is carried in chemical combination with hemoglobin

134
Q

Binding of O2 to hemoglobin with

CO2 release

A

Haldane effect

135
Q

Each gram of hemoglobin combines with how much oxygen

A

1.34 mL

Under normal conditions, 5 ml O2 is transported from lungs to tissues for every 100ml of blood

136
Q

CO2 combines with hgb to form carbaminohgb

This combi is a reversible rxn

A

Transport in combi with hgb (carbaminohgb) 23%

137
Q

Blood contains how much hemoglobin

A

15 g hgb/dl

Under normal conditions 5 ml O2 is transported from lungs to tissues for every 100 ml of blood

138
Q

Drug used to treat glaucoma and high altitude or mountain sickness

Can cause acidosis

Hydrocephalus to dec ICP

A

Carbonic anhydrase inhibitors

139
Q

Maximum volume to which lungs can be expanded with the greatest possible effort 5800mL

VC + RV

A

Total lung capacity

140
Q

Most important components of surfactant

A

1 dipalmitoylphosphatidylcholine

2 Ca ion

141
Q

Blocking the passages leading to alveoli lead to

A

Inc surface tension and collapse creating positive pressure attempting to push the air out

142
Q

Pressure from blocked alveoli attempting to push air out =

A

Pressure = (2xsurface tension)/radius of alveolus

143
Q

Reducing alveolar surface tension

A

Reduces effort required by muscles to expand lungs

144
Q

Pressure is inversely proportional to

A

radius of alveoli

hence in small babies, tendency to collapse is much greater due to greater pressure, smaller radius and lack of surfactant

145
Q

Inspiration 3 fractions

A

1 compliance work / elastic work - req to expand the lungs against lung and chest elastic forces
2 tissue resistance work - req to overcome viscosity of lung and chest wall
3 airway resistance work - req to overcome airway resistance to movement of air into lungs

146
Q

Volume of air inspired or expired with each normal breath amounting to about 500mL in adult male

A

Tidal volume

147
Q

Extra volume of air that can be inspired over and above normal tidal volume when the person inspires with full force

Equal to about 3000 mL

A

Inspiratory reserve volume

148
Q

Maximum extra volume of air that can be expired by forceful expiration after end of a normal tidal expiration

Amounts to 1100 mL

A

Expiratory reserve volume

149
Q

Volume of air remaining in lungs after most forceful expiration

Averages about 1200 mL

A

Residual volume

150
Q

Total Lung Capacity =

A

TLC = IRV + TV + ERV + RV

151
Q

Pulmonary volumes

A

1 TV
2 IRV
3 ERV
4 RV

152
Q

Pulmonary capacities

A

1 Inspiratory capacity
2 functional residual capacity
3 vital capacity
4 total lung capacity

153
Q

Amount of air a person can breathe un beginning at normal expiratory level and distending lungs to maximum amount

IRV + TV
3000 + 500 = 3500 ml

A

Inspiratory capacity

154
Q

Amount of air that remains in lungs at the end of normal expiration 2300 mL

ERV + RV
1100 + 1200 = 2300 mL

A

Functional residual capacity

155
Q

Maximum amount of air a person can expel from lungs after first filling the lungs to maximum extent and then expiring to maximum extent 4600mL

IRV + TV + ERV
3000 + 500 + 1100 = 4600 mL

A

Vital capacity

Medicine (29 decks)

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