Pulmonary anatomy and function Flashcards by Antonio Michell

Obstructive or Restrictive lung disease?

COPD

Obstructive

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True or False

Airway obstruction causes an increase in resistance

True

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It is the sum of all the partial pressures of gases in the air

Atmospheric pressure

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Lung Volumes and Capacities

Is the volume of air still remaining in the lungs after the expiratory reserve volume is exhaled

Residual Volume

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The diaphragm has three opening to allow structures to pass between the thorax and the abdomen

Oesophageal opening
Aortic opening
Vena caval opening

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Why do patients with COPD have chronic hypercapnia?

Due to low ventilation that produces a V/Q mismatch and are unable to alter ventilation to increase exertion of CO2

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What is “shunt” on the lung?

An area of the lung with no ventilation but good perfusion (V/Q of 0)

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The drive to breathe of a patient with COPD is linked to which chemoreceptors?

Peripheral chemoreceptors, that are sensitive to hypoxemia. This is called hypoxic drive

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True or False

Low lung volumes and high lung volumes affects lung compliance

True
Low lung volumes: atelectasis
High lung volumes: Hyperinflation

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Definition: Effect on the pulmonary arterioles due to chronic hypercapnia in a patient with COPD

Persistent Hypoxic Pulmonary Vasoconstriction

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Lung Volumes and Capacities

The maximum value of air exhaled in a specific period of time (1-3 seconds)

Forced Expiratory Volume (FEV)

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Mention all the lobes on the lungs

Right lung: Upper, mid and lower lobe

Left lung: Upper and lower lobe

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In the adults, ventilation is preferentially distributed to the ______ region of the lung. Perfusion is preferentially distributed to the ______ regions of the lung

Dependent - Dependent

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What is compliance?

Refers to the distensibility of an elastic structure (overall stretchiness)

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What is Pimax and why is it useful during extubation?

Maximum inspiratory pressure (Pimax): Reflects the strength of the inspiratory muscles and is often measured to determine a patient’s readiness for extubation

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In this position, there is uniform lung perfusion, improved lung compliance secondary to stabilization of the anterior chest wall, tidal ventilation, diaphragmatic excursion, FRC and reduced airway closure.
Which position is this?

Prone Positioning

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In COPD hyperinflation, which Lung Capacity is mainly affected?

Inspiratory Capacity. Is reduced increasing work of breathing

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True or False

Central chemoreceptors on the ventral surface of the medulla are unaffected by oxygen concentration

True

They are highly sensible to CO2 concentrations and blood acidosis

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Obstructive or Restrictive lung disease?

Amyotrophic Lateral Sclerosis (ALS)

Restrictive

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In active expiration (forceful breathing) there are 6 muscles that act:

Internal intercostals
Abdominal muscles
Rectus abdominis
External oblique
Internal oblique
Transversus abdominis

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This pressure is always negative in relation to intrapulmonary pressure, we are talking about….

Intrapleural pressure (Pip)

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How do pressure changes result in gas flow?

Because gases always follow pressure gradients

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If inspiratory muscles contracts, the intrapulmonary pressure will…

decrease

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In the infant ventilation is preferentially distributed to the ______ lung whereas the perfusion remains best in the ______ regions

Uppermost - dependent

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True or False | Ventilation and perfusion matching is optimal in the mid-lung region

True

True or False | The cartilage in larger airways increase the gas flow resistance

True | Major resistance to gas flow is more common in the upper airwary

How is airways resistance related to the caliber of the airway

less caliber, more resistance | more caliber, less resistance

The medullar roots of the phrenic nerve are

C3, C4 and C5

Total lung compliance = X + X

Chest wall compliance + lung compliance

How many pair of false ribs do we have? Where are they?

Ribs 8 to 10

Asthma is obstructive or restrictive disease?

Obstructive | Is characterized by increased airway resistance and air flow limitation

Where are located the four respiratory control centres?

In the brainstem, specifically on the Medulla and Pons

It is the volume of air expired in one minute: Tidal Volume x Respiratory Rate

Minute Ventilation

Lung Volumes and Capacities | Is the maximum amount of air that can be actively expired after fully inhaling

Total Lung Capacity (TLC) = TV + IRV + ERV + RV

True or False | In acutely ill children with unilateral lung disease, oxygenation may be optimized by placing the "good" lung uppermost.

True

Lung Volumes and Capacities | Is the amount of air remaining in the lungs after a normal expiration

FRC = RV + ERV

Origin of breathing originates in the brainstem, were we can find four main centres:

Inspiratory Centre, Expiratory Centre, Pneumotaxic Centre and Apneustic Centre

The main muscle of inspiration is....

The diaphragm

True or False | Adults with uniformly distributed bilateral lung disease may derive greater benefit when the right lung is lowermost

True Arterial oxygen tension is increased secondary to improved ventilation of the right lung, which may reflect the increased size of the right lung compared with the left.

True or False | When contracting the diaphragm decrease the vertical diameter of the thorax

False | When contracting the diaphragm descends and increases the vertical diameter of the thorax

Main function of pulmonary surfactant

Reduces surface tension and increase pulmonary compliance

Is a zone part of the bronchial tree and it's function is to transport gas in and out of the lungs

Conducting zone

It is the measurement used to describe efficiency and adequacy of matching between ventilation and perfusion which are necessary for gas exchange.

V/Q mismatch

Accessory muscle of inspiration are

Sternocleidomastoid and Scalenes

The passive phase of ventilation is called

Expiration (exhalation)

Ribs ___ are able to do both bucket hand and pump handle movements

6 and 7

Pleura has two layers and a space, describe them from outside to the inside.

Parietal pleura Parietal cavity Visceral pleura

True or False | Reduced total lung compliance produces a decrease of respiratory load

False | Reduced compliance increase the respiratory load and increased work of breathing

Babies born before ___ weeks of gestation may develop infant respiratory distress due to lack of ____

28 weeks - pulmonary surfactant

The diaphragm is innervated by the....

Phrenic nerve

In the presence of COPD, CO2 becomes chronically raised. | What happens to the central chemoreceptors?

Their sensitivity is reduced and they no longer trigger the drive to breathe (because they are sensitive to a reduction in O2 concentration and increase of CO2 concentration)

Is the volume of air left in the lungs at the end of a quiet (passive) expiration.

Functional Residual Capacity

Principal muscles of inspiration are

External intercostals and diaphragm

How many pair of ribs do we have?

In the presence of COPD, CO2 becomes chronically raised. | What happens to arterial blood?

Remains acidotic (low pH)

The point of bifurcation between right and left main bronchi is named

Carina

What characterized a patient with Restrictive Lung Disease?

They cannot fully fill their lungs with air, due to reduced lung complaince.

Obstructive or Restrictive lung disease? | Cystic fibrosis

Obstructive

Lung Volumes and Capacities | Additional air that can be forcibly exhaled after the expiration of a normal tidal volume

Expiratory Reserve Volume (ERV)

If airway caliber decreases, airway resistance....

increases

Lung Volumes and Capacities | The volume of air expired during a forced maximal expiration after max inspiration

Forced Vital Capacity (FVC)

Lung Volumes and Capacities | Is the amount of air inspired during normal, relaxed breathing

Tidal Volume (TV)

The increase of AP diameter of the thorax during inspiration is thanks to the anterior ends of _____ ribs

2 to 5, along with the moment of the sternum

``` True or False Intrapulmonary pressure (Ppul) falls with inspiration and rises with expiration ```

True

Position associated with significant reductions in lung volumes and flow rates and increase work breathing

Supine or recumbent

Obstructive or Restrictive lung disease? | Scoliosis

Restrictive

The parasymphatetic nervous system (PNS) causes ____ in the airway

bronchoconstriction

What is the main goal of positioning technique in terms of volumes and capacities

To reduce closing volume and optimize FRC (Functional Residual Capacity)

Is where the gas exchange takes place and includes the respiratory bronchioles and alveoli

Respiratory zone

What is external respiration?

Is the process of inhaling oxygen from the air into the lungs and expelling carbon dioxide from the lungs into the air.

Chronic obstructive pulmonary disease (COPD) is obstructive or restrictive disease?

Obstructive | Is characterized by increased airway resistance and air flow limitation

On an infant, positioning and postural drainage would require the diseased lung to be uppermost. Why?

Because ventilation is better in the non-dependent region of the lungs, doing this promotes mucus clearance.

Which main bronchi is more angled (45-55 degrees)

Left main bronchi

What is intrapulmonary pressure?

Is the pressure within the alveoli

Receptors B2 are stimulated by _____ as neurotransmitter of the _____ system

catecholamines - Sympathetic nervous system (SNS)

True or False | A positive respiratory pressure is greater than atmospheric pressure

True

Where are the floating ribs?

11-12

In the infant ventilation is preferentially distributed to the ______ lung whereas the perfusion remains best in the ______ regions

Uppermost - dependent

Collateral ventilation is the use of ____, ____ and ____ to provide an alternative route for gas flow.

interalveolar (pores of Kohn), bronchiole-alveolar (canals of Lambert) and interbronchial (channels of Martin)

Which cells secrete pulmonary surfactant and where?

Type II alveolar cells - Alveoli

True or False | In quiet breathing expiration results from passive recoil of lungs

True

The active phase of ventilation is called

Inspiration (inhalation)

Position encouraged to maximize lung compliance, volumes and flow rates and optimizing fluid shifts such that the circulating blood volume and the volume-regulating mechanisms are maintained

Upright position

Mention the two types of ribs movement

Pump handle and bucket handle

What is internal respiration?

Is a metabolic process in which oxygen is released to tissues and carbon dioxide is absorbed by the blood.

Lung Volumes and Capacities | Is the additional air that can be forcibly inhaled after the inspiration of a normal tidal volume

Inspiratory Reserve Volume (IRV)

If intrapulmonary pressure decrease, will create a flow gradient from ____ to ____

outside to the lungs

Pulmonary ventilation involves three different pressures:

Atmospheric pressure Intraalveolar pressure Intrapleural pressure

Which pulmonar functional capacity is most affected with post-operative pain?

Functional Residual Capacity, due to hypo-ventilation in the bases.

Why do patients with obstructive lung disease have shortness of breath?

Mainly due to difficulty exhaling all the air from the lungs (air trapping)

If I increase the volume, the pressure....

decrease

Obstructive or Restrictive lung disease? | Obesity

Restrictive

True or False | Chronic Hypercapnia in a patient with COPD lead to loss of Hypoxic drive

True This is due to the reduced sensitivity of central chemoreceptors and relies on the peripheral receptors to sense arterial hypoxemia and provide a drive to breathe

True or False | Rib one is very mobile and plays a crucial role in respiration

False | Rib one has almost none movement

An example of alterared chest wall compliance is.....

Thorax deformity, obesity, raised of Intra abdominal pressure, ageing

The rationale behind the use of physio techniques when an airway is occluded by a sputum is....

the recruitment of collateral ventilation

The partial pressure of nitrogen in inspired air is equivalent to 78%, while the partial pressure of oxygen is equivalent to...

21%

Intrapleural pressure (Pip) is

the pressure within the pleural cavity

Lung Volumes and Capacities | Total amount of air that can be expired after fully inhaling

Vital Capacity (VC) = TV + IRV +ERV

An area of the lung with reduced perfusion but good ventilation is termed...

Alveolar dead space

From outside to inside order: Bronchi - Alveoli - Main bronchi - Respiratory bronchioles - Terminal bronchioles - Segmental Bronchioles - Lobar bronchi - Segmental bronchi

``` Main bronchi Lobar bronchi Segmental bronchi Bronchi Bronchioles Terminal bronchioles Respiratory bronchioles Alveoli ```

What is pulmonary ventilation?

Is the process of air flowing into the lungs during inspiration and out of the lungs during expiration.

True or False | Bases are less compliant during positioning technique, so they exhibit greater volume changes during ventilation

False | Bases are MORE compliant during positioning technique, so they exhibit greater volume changes during ventilation

True or False | Peak Expiratory Flow (PEF) cannot be used to detect restrictive lung disease

True | PEF forms part of the assessment and management plan in asthma.

Causes the patient to become hyperinflated, giving rise to the characteristic barrel shaped chest

Air Trapping

Obstructive or Restrictive lung disease? | Asbestosis

Restrictive

Obstructive or Restrictive lung disease? | Idiopathic pulmonary fibrosis

Restrictive

Persistent Hypoxic Pulmonary Vasoconstriction can lead to ______ on the right ventricle.

Hypertrophy is due to an increase in the work to send blood through these narrowed vessels.

Obstructive or Restrictive lung disease? | Asthma

Obstructive

Lung Volumes and Capacities | Is the maximum amount of air that can be inspired

Inspiratory Capacity (IC) = TV + IRV

Is it more probable to have aspiration on the ____ lung in an upright position

Right lung

When the transpulmonary pressure becomes zero, we are under the presence of a....

Pneumothorax

Inspiration causes the anterior ends of ribs ____ to move un an upwards and outwards direction

8 to 10