Quiz 4

Question 1

Quiz 4 is on:

Answer 1

• Dr. Henkin’s online module over review of respiratory anatomy
• Dr. Henkin’s module she went over in class on 3/13 on respiratory system.
  THAT IS IT

Question 2

1) What are the anatomy parts included in the respiratory system:
2) Primary purpose of respiratory system
3) The respiratory system has an upper respiratory system / tract and lower respiratory system / tract. Name structures in each:

3A)

• Function of the upper respiratory tract?
• Function of the lower respiratory tract?

4) T or F: The respiratory system has all 4 types of tissue? (And what are all 4 types)
5) Tracheal bifurcation is at what landmark
6) The parietal pleura extends how far PAST the actual lung?

Answer 2

1)
- Skeletal (ribs)
- Muscles (Ex. intercostal, diaphragm, etc.)
- Nervous (phrenic n, intercostal n’s, etc. )
- Vasculature (pulmonary a’s and v’s)
- Viscera (lungs)
- Nasal cavity (vestibule, sinuses, nasal conchae), pharynx (3 parts), larynx, trachea, bronchial tree (bronchi and bronchioles), alveoli, lungs, etc.

2) Gas exchange (and air conduction)

3)
UPPER:
- Nasal cavity (vestibule, sinuses, nasal conchae)
- Pharynx (3 parts)

LOWER:

• Larynx
• Trachea
• Bronchi (then each segment of bronchial tree … which is reviewed in slide below)
• Alveoli
• Lungs

3A)

• Upper: filters, warms, and humidifies air (starts air conduction down)
• Lower: Continues to conduct air down, and GAS EXCHANGE

4) True (Muscular, Nervous, Connective, Epithilial)
5) Sternal angle
6) Typically 2 rib spaces

Question 3

Review general landmarks for lungs:

Answer 3

Review this: https://quizlet.com/90674009/lung-lobe-landmarks-flash-cards/

Question 4

1) There are 4 different types of NORMAL breath sounds. What are they
2) Where would you auscultate to hear each of these
3) Explain the type of sound you’d hear at each spot

Answer 4

1) Tracheal, bronchial, bronchovesicular, vesicular

2)

• Tracheal: Over trachea
• Bronchial: Just to right and left manubrium in 2nd intercostal space
• Bronchovesicular: anteriorly in 1st and 3rd intercostal spaces, posteriorly between scapula
• Vesicular: Peripheral lungs (all over)

3)
- Tracheal: Loud, harsh, high pitched
- Bronchial: Loud, high pitched
- Bronchovesicular: medium intensity and pitch
- Vesicular: softer, lower pitched

Question 5

1) What are Adventitious breath sounds?

2) 2 different types of adventitious breath sounds are:
- Give examples of each

3) Which adventitious sound is low pitched, which is high pitched

Answer 5

1) Adventitious breath sounds are ABNORMAL sounds that are heard over a patient’s lungs and airways. These sounds include abnormal sounds such as discontinuous fine and coarse crackles (crackles are also called rales), or continuous wheezes (or rhonchi), stridor, or pleura rubbing together.

2) DISCONTINUOUS OR CONTINUOUS
- Crackles or rales: brief DISCONTINUOUS crackling sounds heard during INSPIRATION (popping)
- Wheezes and Rhonchi: CONTINUOUS sound as air travels through narrowed bronchial airways (from foreign bodies) during IN/EXPIRATION. From Asthma or COPD
- Stridor: obstruction of trachea or larynx (distress breathing … kid with croop. Loud and harsh.)
- Pleural friction rub: pleural surfaces are rubbing together from inflammation

3) Low is rhonchi, high is wheezes

Question 6

1) Dermatomes of thoracic wall … T3 is at what landmark, T4, T7, and T10

1A) PSIS is at what level, ASIS is at what level, iliac crests are at what level,

2) Inferior border of the scapula is typically around what landmark?
3) Spine of scapula is about what level of vertebrae

Answer 6

1) T3 is spine of scapula, T4 is nipple line, T7 is xiphoid process (anterior and inf. angle of scapula posterior), and T10 is umbilicus

1A) PSIS and ASIS are about the same level (S2), iliac crest around L4

2) 7th intercostal space (T7)
3) T3

Question 7

REVIEW …

1) Classify the 3 different types of ribs
2) What rib is associated with the sternal angle or manubriosternal jt?
3) What rib is associated with xiphisternal jt?
4) What are the “typical ribs” and “atypical ribs”
5) As volume of the thoracic cavity increases (air coming into lungs), will pressure increase or decrease in the lungs/thoracic cavity?

Answer 7

1)
- Vertebrosternal (TRUE) ribs: 1-7
- Vertebrochondral (FALSE) ribs: 8-10
- Vertebral (FREE) or Floating ribs: 11-12

2) Rib 2
3) Rib 7
4) Ribs 3-9 are typical, 1,2,10-12 are atypical
5) As volume increases, pressure DECREASES

Question 8

Diaphragm:

1) 3 parts of diaphragm

2 Those 3 parts join into what at the attachment point?

3) 3 things (technically 4) pass through diaphragm … at what level?

4)
- Would being pregnant or obese impact diaphragm? How?
- What about a COPD patient?

Answer 8

1) sternal, costal, lumbar
2) central tendon
3) inf vena cava (T8), esophagus (T10), aorta (T12) (and 2 other openings for psoas muscle)

4)
- Yes. More fat in abdomen (obese or pregnant) doesn’t allow diaphragm to descend as much, making it harder to breath, thus less O2 coming in, etc. This impacts both abdominal and thoracic pressures.
- For a COPD patient, they can’t get air OUT. So, air will collect in thorax, so pressure exchange between abdomen and thorax is altered (higher pressure in abdomen helps venous blood return up against gravity).

Question 9

1) When air first enters our nasal cavity, what happens to it
2) What area does air go after nasal cavity … and what are the 3 parts:
3) 3rd part that air goes through
4) 4th part air goes through
5) So, go from when air first enters and follow it through path all the way down to alveiolar ducts
6) Explain how the L and R main/primary bronchi are different … why, and what it means
7) What is happening at alveolar sacs
8) Both R and L lung have an oblique fissure, but the R lung has another fissure =
9) Remember the LEFT lung has a cardiac notch for heart, and lingula - space projecting out, and both have the hilum where vessels enter

10 What two nerves innervate lungs … and where would you find them?

11) Remember the pleural recesses. What are they?

Answer 9

1) It is warmed, filtered, and humidified
2) Pharynx. Nasopharynx, oropharynx, laryngopharynx
3) Larynx
4) Trachea

5)
- Nasal cavity (vestibule, sinuses, nasal conchae)
- Pharanyx (3 parts: nasal, oral, larynx)
- Larynx
- Trachea
- Main Bronchi (left and right main bronchus)
- Lobar Bronchi (lobar bronchus for each lobe … 3 on right)
- Segmental bronchi
(ABOVE 3 are primary, secondary, tertiary bronchi)
- Terminal bronchioles
(HERE IS SEPERATION BETWEEN CONDUCTING AND RESPIRATORY systems)
- Respiratory bronchioles
- Alveolar ducts
- Alveolar sacs (which are made up of alveoli)

6) The right side is shorter, wider, and more VERTICAL (since Left side has heart). This means you can get foreign material (food, liquid) down RIGHT side easier.
7) Gas exchange … capillaries where gas exchange happens.
8) Horizontal fissure
9) ok
10) Phrenic and vagus. Phrenic is anterior the hilum and vagus is posterior to hilum (Vagus belongs in the back :)
11) Costodiaphragmatic, costomediastinal. Basically the area where parietal pleura butt up to the other side of the parietal pleura.

Question 10

BELOW ARE FLASHCARDS ON LECTURE 2 of Dr. Henkin’s Respiratory Lectures

1) Divide the respiratory system into two separate anatomical portions, and what structures are in each:
2) Divide the respiratory system into two separate physiological portions, and what is function in each:
3) What are the main functions of the respiratory system:
4) Conducting portion ends where
5) Respiratory portion begins where

Answer 10

ok

1)
UPPER RESPIRATORY TRACT: Nose, nasal cavity (vestibule, sinuses, nasal conchae), phranyx (nasal, oral, larynx parts),
LOWER RESPIRATORY TRACT: Larynx, trachea, main bronchi, lobar bronchi, segmental bronchioles, terminal bronchioles, respiratory bronchioles, alveolar ducts, alveolar sacs, alveoli (also: lungs, pleura, recesses, diaphragm).

2)

• Conducting System: Transmits the air (from nose down to terminal bronchioles) and filters, humidifies, and warms air.
• Respiratory System: Gas exchange (from respiratory bronchioles down to alveolar sacs)

3)
- Gas exchange (O2 and CO2)
- Move air along respiratory passageways (a highway for air … CONDUCTING)
- Warm, filter, and humidify air
- Defend against foreign objects, pathogens, infections … coughing / filtering (create mucous and muscociliary escalator gets gunk out).
- Produce sound (speaking, sing)
- Help with smells

4) Terminal bronchioles
5) Respiratory bronchioles

Question 11

1) ** Alveolar sacs are just a collection of ________
2) ** 4 types of tissues
3) Review the different types of epithilial tissue and brief function of each

Answer 11

1) Alveoli
2) Muscular, Nervous, Connective, Epithilial

3)
- Simple squamous (gas filtration, secretion)
- Simple cuboidal (secretion and absorption)
- Simple columnar (secretion and absorption)

• Stratified squamous (protection)
• Stratified cuboidal (protection)
• Pseudostratified columnar (lines upper respiratory tract)
• Transitional

Question 12

NASAL CAVITY

1) Nasal cavity is important for doing what:
2) Anterior opening of nasal cavity is called:
3) What type of cells line the anterior opening
4) When all cells touch basement membrane but look like they are stratified, it is called:
5) Posterior to the vestibule is the _________, and they are what:
6) From #5 ? above, it has how many parts, and what type of cells are lining each part:

Answer 12

1) Filtration, humidification, and warming of air
2) Vestibule
3) Keratinized epithilium in the front/anterior, then as you move more posterior, it becomes pseudostratified columnar
4) Pseudostratified columnar cells
5) Nasal Conchae … little bones.

6) 3
- Superior: olfactory epithilium (pseudostratified columnar epithilium)
- Middle: respiratory epithelium (pseudostratified ciliated columnar epithilium … PSCCE)
- Inferior: respiratory epithelium (same as above)

Question 13

1) So what is PSCCE:

1A) Is PSCCE synonymous with Respiratory Epithilium

2) Where is it found?
3) Where do you find olfactory epithilium

Answer 13

1) Pseudostratified Ciliated Columnar Epithilium …. respiratory eptithilium. They are cells that line the respiraatory tract to help create mucous (catch foreign material … cilia are hair like cells to catch and move material) and get rid of gunk to protect respiratory lining / airways.

1A) YES

2) Lining the middle and inferior nasal choncae, nasopharynx, and then in lower places as you move deeper into respiratory system (lower larynx, trachea, bronchi, bronchioles).
3) Back (posterior) of vestibule, and then the superior nasal conchae.

Question 14

Explain how we smell.

Answer 14

Molecules land on the olfactory epithilium (pseudostratified columnar epithilium of superior nasal conchae) and those small molecules hit little tinny hairs (cilia) that send a nervous signal through olfactory nerve back to the brain to detect and process the smell.

Question 15

1) Our Respiratory Epithilium (PSCCE) has how many types of cells:
2) What are those 5:

2A) Her test ?’s will come from which of those 5 cells

3) What is the role of Goblet cells

3A) What is role of ciliated columnar cells?

4) What is the mucociliary escalator

5A) Where does the mucociliary escalator start (inferiorly)?

5) What other way do we get gunk up and out?
6) Most abundant cell in respiratory epithelium is:

Answer 15

1) 5
2) Goblet cells, Ciliated columnar cells, brush cells, granule cells, basal cells

2A) Goblet cells and Ciliated columnar cells.

3) Goblet cells PRODUCE MUCOUS to catch the foreign material, and they work with ciliated columnar cells (hair to move things) to create the MUCOCILIARY ESCALATOR to trap foreign substances and push them up and back out of respiratory tract (or help you swallow them).

3A) These are the hair like cells to MOVE things out of the respiratory tract … anything that gets stuck in the mucous (produced by Goblet cells) will be moved UP and OUT by these ciliated columnar cells (or swallowed).

4) The mucociliary escalator is a major barrier against infection. Microorganisms hoping to enter or infect the respiratory tract are caught in the sticky mucus (goblet cells) and moved up (by ciliated columnar cells) and out by the mucociliary escalator (combination of both types of cells).

5A) Bronchioles

5) Coughing, but with the help of mucuciliary escalator
6) Ciliated columnar cells

Question 16

1) An example where the mucociliary escalator gets compromised or ruined?
2) Explain the changes that occur to cells as a result of smoking … and why is that so critical?

Answer 16

1) Smokers … it paralyzes the mucociliary escalator after an episode of smoking (that is why they have to cough and try to get the gunk out of respiratory airways). Chronic smokers, the escalator just never works since they are constantly smoking.
2) Normal cells get damaged (from smoking), and they become dysplasia cells. Those move to metaplasia where the cell actually changes (from simple to stratified epithilial cell). Then to neoplasia where cancer results. SO … if cells get ruined, not only could you develop cancer, but it could impact gas exchange at the alveoli level in lungs.

Dysplasia > metaplasia > neoplasia > anaplasia (cancer)

Question 17

PHARYNX

1) What are the 3 sections of the Pharynx
2) What types of cells are in each of these 3 areas
3) If someone is trached, what are they missing:

Answer 17

1) Nasopharynx, oropharynx, and larynopharynx.

2)
- Naso: PSCCE
- Oro: Stratified squamous epithelium
- Laryno: Stratified squamous epithelium

3) They are missing some filtering, warming, humidification, and the upper mucociliary escalator won’t work (… people who are trached will have the air warmed and humidified for them).

Question 18

LARYNX

1) Explain how the larynx is composed histologically
2) Key piece to the larynx is:
3) #2 above is what type of epithilium. Why?

Answer 18

1) Larynx is primarily cartilage
2) Epiglottis

3) Superiorly it is stratified squamous, and inferiorly down in respiratory tract it is PSCCE
- Above is stratified squamous for protection (of food descending), and PSCCE below for helping get gunk up out of throat.

Question 19

TRACHEA

1) Now with the trachea, what is the inner trachea histologically composed of:
2) What is the outer portion of the trachea composed of … and explain it, function, anatomy anteriorly and posteriorly around entire trachea.
3) Why does back of trachea NOT have cartilage

Answer 19

1) Lined by PSCCE (respiratory epithelium)
2) Cartilage. It is c shaped in rings going down antero-laterally, and this cartilage protects the trachea and prevents overexpansion. But around the back / posterior side of the trachea there is NO cartilage, because that is where esophagus is (thus as esophogus expands with food/bolus, it can bulge into trachea a bit).
3) So as you swallow, the espophogus can expand a bit as food passes through, so the posterior trachea is more flexible.

Question 20

1) What is different about the RIGHT main bronchus to the LEFT. WHY?
2) Why is this important

Answer 20

1) Right is bit shorter, wider, and MORE VERTICAL. It has to do with the fact that the heart is on the left side, which makes the left side less vertical and longer.
2) The right side is where it is easier for food or liquid to enter if it gets through airway (aspiration).

Question 21

BRONCHI

1) The bronchi are interiorly lined with what cell type histologically
2) Bronchi walls contain what 3 things
3) As you move down the trachea, and bronchi, there will be less ________ and more ____________
4) Do Bronchi have any glands? Why?
5) When we say “bronchi” what are we talking about:

Answer 21

1) PSCCE (respiratory epithelium)
2) Cartilage, smooth muscle, and elastic fibers
3) Less cartilage, more smooth muscle
4) Yes, to help keep it slick and smooth and wet
5) Primary, secondary, tertiary bronchi … main, lobar, segmental bronchi.

Question 22

BRONCHIOLES

1) Is there cartilage now covering bronchioles
2) So explain outer lining of bronchioles

2A) Are there glands in bronchioles?

3) If you get sympathetic stimulation, bronchioles will do what?
4) If you get parasympathetic stimulation, bronchioles will do what?

4A) Do bronchi also dilate and constrict during sympathetic/parasymptathetic stimulation?

5) If bronchioles dilate, you get less _________, allowing ____________, which results in more ___________
6) When we say bronchioles, what are we talking about:

Answer 22

1) No
2) Smooth muscle and elastic fibers

2A) NO

3) Dilate (bronchodilation)
4) Constrict (bronchoconstriction)

4A) Not really (maybe a little), but they have more cartilage, so there is thus less dilation/constriction. The bronchioles do dilate/constrict since they are smooth muscle.

5) Resistance, allowing more air flow to get to where it needs, which results in more gas exchange.
6) Terminal bronchioles, and respiratory bronchioles

Question 23

TERMINAL BRONCHIOLES

1) The terminal bronchioles is the part where what section/portion ends and what begins?
2) What are the main cells in the terminal bronchioles?
3) From #2, why are these cells so important?
4) Terminal bronchioles become what?
5) What has more smooth muscle, the terminal bronchioles or the respiratory bronchioles?

Answer 23

1) Conducting system ends, respiratory system begins.
2) Clara cells
3) They coat or line bronchioles … produce a SURFACTANT type product … and they detoxify substances breathed in.
4) Respiratory bronchioles
5) Terminal

Question 24

RESPIRATORY BRONCHIOLES and ALVEOLI:

1) T or F: Respiratory bronchioles are the smallest bronchioles?
2) They open into ________, which open into _________, which contain _________
3) What happens in alveoli
4) Is there smooth muscle in the alveoli?
5) What surrounds the alveoli? Why?
6) What are the two (actually 3) main types of cells that make up the alveoli … and each of their functions

6A) Another name for Type I and Type II pneumocytes?

7) What is the purpose of surfactant

*** 8) So what do Type II pneumocytes do

9) When is an infant OK to be born, meaning they have fully developed lungs and surfactant is produced sufficiently?
10) So if we lacked surfactant, what would happen?

Answer 24

1) True
2) Alveolar ducts, alveolar sacs, alveoli
3) Gas exchange
4) NO
5) Elastic fibers. They allow the alveoli to recoil and return to their original shape after air comes in and then leaves.

6)
- Type I pneumocytes (simple squamous) … gas exchange
- Type II pneumocytes (cuboidal cells) … produce and secrete surfactant
- Macrophages: eat up debry

6A) Type I and Type II Alveolar cells

7) Surfactant REDUCES SURFACE TENSION of fluid in the lungs and helps make the small air sacs in the lungs (alveoli) more stable. This keeps the alveoli from collapsing when an individual EXHALES because the liquid film if it had surface tension would stay bound and thus COLLAPSE.
8) Lamaller bodies in these cells MAKE SURFACTANT, release/secrete it to the surface of the alveoli … because surfactant DECREASES SURFACE TENSION SO THAT ALVEOLI DO NOT COLLAPSE.
9) 36 ish weeks is when lungs are mature enough to produce enough surfactant (prior to 36 weeks, the baby needs artificial surfactant put in body/lungs to live).
10) We’d have surface tension in alveoli, and then alveoli would COLLAPSE during EXPIRATION, so it would result in impaired gas exchange, which leads to a ton of other issues.

Question 25

GAS EXCHANGE

1) The area or barrier where gas is exchanged is called:

1A) 2 main functions from #1

2) Air is separated from capillary bed via three things:
3) How does O2 and CO2 cross barrier to get in / out of blood (capillary)
4) How does #3 work?
5) Connection or channel between 2 alveoli is called:

Answer 25

1) Blood air barrier

1A) Physically separates air from blood (barrier), and allows gas exchange

2)
- Type I pneumocytes
- Fused basement membranes (Type 1 pneumocyte cells and capillary cells)
- Endothilial cells of capillary (wall of capillary)

3) Diffusion
4) Molecules move from areas of HIGH CONCENTRATION to LOW CONCENTRATION. In alveoli, O2 is highly concentrated, but it is low in capillaries, so O2 moves into capillaries. Visa versa for CO2. It is highly concentrated in capillaries, but low in alveoli, so CO2 diffuses to alveoli to be exhaled out.
5) Alveolar pore

Question 26

RESPIRATORY / PULMONARY PATHOLOGY:

1) What are the two arms / branches of respiratory pathology:
2) Explain the difference between each from #1 ?
3) What are some examples of both these 2 pulmonary pathologies from #1

3A) Big overarching term for the obstructive disorders of #3 question above

4) What are main characteristics of Asthma
5) What is the hallmark s/s of Asthma
6) Explain chronic bronchitis
7) Explain Emphysema

Answer 26

1) Obstructive and restrictive

2)
- Obstructive: air flow is IMPEDED/OBSTRUCTED (problem in air flow).
- Restrictive: VOLUME of air is being REDUCED (I can’t expand the lungs).

3) 
OBSTRUCTIVE:
- Asthma
- Emphysema
- Bronchitis
(COPD is bigger term for these conditions)

RESTRICTIVE:

• Obesity
• Pregnancy
• Weak thoracic wall muscles
• Scoliosis, muscular dystrophy

4) It is an obstructive pulmonary disorder, airways obstructed by some reaction so smooth muscle restricts, mucus builds up, hyper sensitivity, inflammation, mucous production … triggered by a toxin or allergy or even exercise.
5) Periods of normal function, then periods of non-normal function (and responds to medication)
6) Chronic bronchitis is an INFLAMMATION OF AIRWAYS. It results in coughing (with phlegm) that you have every day, and that occurs often. The inflammation occurs when the tiny hair-like projections — called CILIA — that line your bronchial tubes are DAMAGED. Normal cilia help propel mucus up the bronchial tubes. But when cilia are damaged, it becomes harder to cough up mucus, which in turn causes more coughing, more irritation, and more mucus production.
7) Emphysema occurs when the tiny air sacs (ALVEOLI) in your lungs — the alveoli — break down (elastic fibers around air sacs get ruined) and so the alveoli become LARGER. With the destruction of the alveoli, your lungs are less able to get oxygen out of the air and less effective at getting rid of carbon dioxide (gas exchange). The walls of the damaged air sacs are stretched and less flexible, so that air is trapped inside the lungs.

Question 27

RESPIRATORY PHYSIOLOGY

1) There are 2 processes for respiration (gas exchange). What are they … explain them
2) Is Ventilation and Respiration the same thing?
3) Explain Boyle’s law
4) How does Boyle’s law relate to respiration?
5) T or F: Air moves from low pressure to high pressure
6) What main muscles do we use for INSPIRATION:
7) What main muscles do we use for EXPIRATION:

8)
- So at the start of expiration (exhale), would pressure be greater IN or OUT of the lungs?
- Then at start of inspiration (inhale), would pressure be greater IN or OUT of the lungs?

Answer 27

1) External and Internal respiration.
- External: Exchange of O2 and CO2 between alveoli and capillaries (blood air barrier) in the LUNG.
- Internal: Exchange of O2 and CO2 between CAPILLARIES in body tissues (systemic capillaries)

2)
- Ventilation is the breathing part (inspiration and expiration of air)
- Respiration is the GAS EXCHANGE part

3) Boyles law simply states that as the VOLUME increases, the PRESSURE will decrease. And as the volume DECREASES, the pressure will INCREASE … INVERSELY PROPORTIONAL
4) As we take a breathe, we increase the volume in the lungs and thus decrease the pressure. Air moves from HIGH to LOW pressure. Then as we exhale, the volume decreases and so the pressure increases (air moves out of lungs from high pressure to low pressure)
5) FALSE. From high pressure to low pressure
6) Diaphragm and Ex. intercostal m’s
7) Diaphragm relaxes, but Internal Intercostal m’s (help of abdominals during forced expiration)

8)
- IN the lungs
- OUT of lungs
(Just think where air is moving to, and it goes from higher concentration to lower concentration).

Question 28

1) What is a pneumothorax
2) A pneumothorax results in what?

2A) Another name for #2 above

3) If blood enters pleural space/cavity, it is called a:
4) What is a tension pneumothorax … why is it so dangerous?

Answer 28

1) When air (or liquid, puss, blood, object) gets into pleural cavity between parietal pleura and visceral pleura of lung(s)
2) Collapsed lung … so decreased lung volume, thus decreased gas exchange.

2A) Atelectasis

3) Hemothorax
4) When air gets IN pleural space but can’t escape … so you get pressure on surrounding tissues, and this causes a MEDIASTINAL SHIFT which is very dangerous.

Question 29

PULMONARY VENTILATION:

1) What is the difference between airway resistance and airway compliance

2)
- If resistance goes up, what happens to air flow?
- If resistance goes down, what happens to air flow?

3)
- Bronchoconstriction does what to resistance?
- Bronchodilation does what to resistance?

4) T or F: The less the resistance, the easier air flows through airways

5)
- If we had higher lung compliance, would that allow us to expand lungs more or less?
- If we had lower lung compliance, would it be more difficult or easier to expand lungs?
- What is the balloon analogy with regards to compliance

6)
- With emphasemza, are alveoli bigger or smaller?
- So would that make lungs more or less compliant?

Answer 29

1)
- Airway resistance is how much FORCE is needed to inflate and deflate the lungs (which could be impacted by an obstructive COPD issue).
- Airway compliance relates to how easily the chest wall expands (elastic ability). It’s the FLEXIBILITY / ELASTICITY of the chest wall.

2)

• Airflow goes down
• Airflow goes up

3)
- Makes resistance increase (less air flow)
- Make resistance decrease (more air flow)

4) True

5)
- More expansion

• More difficult
• If a balloon can be blown up easier, it is more compliant. So higher compliance = ease of expansion / more flexible (a highly compliant balloon is easily stretched and blown up quicker).

6)
- Bigger (hyper-inflated)
- More compliant

Question 30

PULMONARY VOLUMES

1) Review all the volumes … know about what is in the graph, amounts (in mL), and meaning of each
2) What is it called for just normal breathing
3) Amount of air you can forcefully inhale above TV
4) TV inhale + IRV =
5) Amount of air you can forcefully exhale out past TV =
6) Amount of air you can never forcefully exhale out, or after maximum exhale what is left in lungs =
7) Amount of air you can forcefully exhale + amount left in lungs you can’t exhale … or air left in lungs after normal tidal volume =
8) Amount of normal breathing + IRV + ERV =
9) ALL OF IT
10) Define minimal volume

Answer 30

1)
- Tidal Volume (TV) … 500 mL
- Inspiratory Reserve Volume (IRV) … 3000 mL
- Inspiratory Capacity (IC = TV + IRV) … 3500 mL
- Expiratory Reserve Volume (ERV) … 1200 mL
- Residual Volume (RV) … 1200 mL
- Functional Residual Capacity (FRC = ERV + RV) … 2400
- Vital Capacity (VC = TV + IRV + ERV) …
- Total Lung Capacity (TLC) … all of it

2) Tidal Volume (TV)
3) Inspiratory reserve volume (IRV)
4) Inspiratory capacity (IC)
5) Expiratory reserve volume (ERV)
6) Residual volume (RV)
7) Functional residual capacity (FRC)
8) Vital Capacity (VC)
9) Total Lung Capacity (TLC)
10) Amount of air in lungs if your LUNGS COLLAPSED.

Question 31

1) What is the term for the amount of air you can move through you per minute
2) Number of breaths per min

2A) Normal RR

3) Equation to find out how much air moves through system in a minute (Ve)
4) Equation to know how much air is getting to alveoli (Va)
5) If we increase the RR, would we get increased or decreased alveolar air / ventilation?
6) If we lower our tidal volume, would we increase or decrease amount of air to alveoli?

Answer 31

1) Respiratory minute volume (Ve)
2) Respiratory rate

2A) 12-20 bpm

3) Ve = RR x TV
4) Va = RR x (TV - Dead space air left over)
5) Increased
6) Decrease

Question 32

OXYHEMOGLOBIN DISSOCIATION CURVE (HbO2)

1) How many O2 molecules can a hemoglobin molecule carry?

1A) What is a saturated hemoglobin molecule

2) What is the oxyhemoglobin dissociation curve?
3) So what does oxyhemoglobin dissociation mean?
4) So will the lungs be highly saturated or low saturation and why?

5)
- What would HbO2 be in resting tissues
- What would HbO2 be in working (exercising) tissues
- Why is knowing this important?

6) Difference between SpO2 and SaO2
7) What 2 things shift the HbO2 saturation curve?

- If pH increases, Hb releases more/less O2
- If pH decreases, Hb releases more/less O2
- Alcalodic is above what, and acidodic is below what
- so if pH decreases, would you have more or less O2

- If it is a colder temp, what does Hb do?
- If it is warmer, what does Hb do?
- So what happens during exercise?

Answer 32

1) 4

1A) One with 4 O2 molecules bound to the Hb

2) Shows the relationship between Hemoglobin saturation and pressures of oxygen … what areas of the body will have highly saturated Hb molecules bound to O2, and which areas will be non-saturated.
3) O2 needs to unbind from hemoglobin (Hb) to get to tissues. And it does that throughout body, but diff. parts of body need more O2 than others, so it dissociates differently throughout the body.
4) Lungs are HIGHLY saturated … because they just got the O2 and needs to take it to body, and gets its own blood supply.

5)
- Resting: Hb still highly saturated (but losing some)
- Working/Exercising: Hb and O2 are dissociating and becoming much less saturated.
- Because we don’t want Hb to have O2 bound to it in working tissues cause that tissue needs the O2

6) (S = saturation, p = peripheral, a = arterial). SpO2 simply means that the SaO2 was measured using pulse oximetry peripherally. Very simply, SpO2 is an indirect measurement of the oxygen content of blood (oximetry) where SaO2 is a direct measurement of the oxygen content of the blood obtained from the arteries (arterial blood gas sampling).
7) pH and temperature

 - Less  (so it's more saturated)
 - More  (so it's less saturated)
 - Alcalodis is above 7.45, acidodic is below 7.35 (range 
   of optimal is 7.35-7.45
- So if curve shifts UP (pH goes up), then Hb won't give up O2 as easily. But if curve goes DOWN (pH goes down), then Hb will give up O2 easier. 
 - Less O2, more CO2

 - Colder: Hb holds on to O2 more
 - Warmer: Hb releases O2 more
 - You warm up, so Hb releases more O2 easier for 
    the exercising tissues needing more O2

Question 33

CO2:

1) If pH decreases, would you have more or less CO2
2) The end product of aerobic metabolism?
3) Once CO2 leaves tissues (waste product of metabolism), it goes into the blood. What are the 3 things that can happen to CO2 once it leaves the tissue:

4)

• If CO2 is leaving TISSUES to enter blood (at capillary), is it external or internal respiration?
• If CO2 is leaving blood to diffuse to the ALVEOLI in lungs, is it external or internal respiration?

Answer 33

1) More
2) CO2

3)
- Dissolves into plasma
- Converts to carbonic acid (H2CO2)
- Binds to hemoglobin (Hb)

4)

• Internal
• External

Question 34

V/Q Ratio

1) V stands for:
2) Q stands for:
3) Explain the V/Q ratio:

3A) Ideal V/Q ratio would be around:

4) T or F: V/Q ratio’s differ depending on where you are in the lung?
- Would ventilation be more in the apex or base of lung? Why?

5) If you have a high ventilation / perfusion (V/Q) ratio, is ventilation going to be high or perfusion?
6) If we have a low V/Q ratio, what does that mean?

7)
- What is an example where V is impacted, and what would V/Q ratio be?
- What is an example where Q is impacted, and what would V/Q ratio be?

8) V/Q mis-matching means:

Answer 34

1) Alveolar ventilation
2) Alveolar perfusion. Pulmonary blood flow (perfusion), or blood going through alveoli’s
3) V/Q ratio can therefore be defined as the ratio of the amount of air reaching the alveoli per minute to the amount of blood reaching the alveoli per minute—a ratio of volumetric flow rates. These two variables, V and Q, constitute the main determinants of the blood oxygen (O2) and carbon dioxide (CO2) concentration.

3A) 1

4) True
- Apex has higher ventilation, base of lung has less ventilation and more perfusion. Why? Blood weighs more than air, so gravity pulls more blood down in lungs.

5) Ventilation (highly ventilated)
6) Ventilation is low (or perfusion is higher)

7)
- V = obstructed airway, so really low ventilation and thus low V/Q ratio.
- Q = pulmonary embolism, so high ventilation and low perfusion, so high V/Q ratio.

8) If we have obstructed airway, then we are getting less O2 (less ventilation). But if we have an embolism, we get less blood. Thus, our V/Q ratio is mismatched.

Question 35

Recap … starting in nasal cavity and go all the way down to the alveoli, list what the histology (what type of cells) line each area along the respiratory system:

Answer 35

• Vestibule: keratinized epithelium in anterior vestibule, and pseudostratified columnar epithelium posteriorly in vestibule
• Superior Nasal Conchae: olfactory epithelium
• Middle Nasal Conchae: PSCCE (respiratory epithelium)
• Inferior Nasal Conchae: PSCCE (respiratory epithelium)
• Nasopharynx: PSCCE
• Oropharynx: Stratified squamous epithelium
• Larynopharynx: Stratified squamous epithelium
• Larynx (above epiglottis): Stratified squamous epithelium
• Larynx (below epiglottis): PSCCE
• Layrnx: PSCCE
  
  • Outer layrnx is cartilage
• Outer trachea: Cartilage (c shaped peicies anterolaterally, and no cartilage on posterior side)
• Inner trachea: PSCCE
• Bronchi (main, lobar, segmental): PSCCE
  *** with less cartilage as you move down, and more
  smooth muscle
• Terminal Bronchioles: Clara Cells
  
  • Produce surfactant
• Alveoli:
  
  • Type I pneumocytes (simple squamous) … gas
    exchange
  • Type II pneumocytes (cuboidal cells) … produce and
    secrete surfactant
  • Macrophages: eat up debry
    (Or called Type I and Type II Alveolar cells)

Question 36

1) Explain what surfactant actually does:

2) What is surface tension

Answer 36

1) Without surfactant, fluid molecules that line the alveoli form bonds with one another. This surface tension creates an inward pull that “wants” to collapse the alveolus. With surfactant, the ability of the fluid molecules to form bonds is interrupted by surfactant. Surfactant is a substance that contains phospholipids—the important part about this is that there is a hydrophilic end that loves water and a hydrophobic end that does not like water. Like attracts like, so the hydrophobic areas attract each other and line up on the surface of the alveoli. The hydrophilic ends attract each other as well. So… if surfactant is present, it interrupts the inward pull that is relatively strong in the absence of surfactant. This is what helps keep the alveoli open.
2) It is the liquid / film being pulled together by molecule attraction. This helps keep surface bound and tight … tension (like example of dropping water into already bulging water. So surfactant distrupts this attraction of the molecules.