RESP 1 Flashcards
What is pleural effusion?
excess fluid in thepleural space, which makes lung expansion difficult so the person will breathe shallow and fast
Someone with pleural effusion will breathe…
shallow and fast
What is PIP?
subatmospheric pressure, which ensures that the lungs are held to the chest wall and will move with the chest wall during inspiration & expiration.
What is Patm?
atmospheric pressure
- 760 mmHg
Does a healthy lung have all three zones?
No… just zone 2 and 3
There is _________ ventilation (V) of alveoli and blood flow (Q) into capillaries in zone 3.
greater
What do the zones of the lung differ in?
amount of air (ventilation; V)
blood (perfusion; Q)
Why is there more airflow to zone 3?
alveoli are more compliant
What is the significance in increased surface area in the respiratory zone?
enhance gas exchange
What are the implications of decrease in cartilage and increase in smooth muscles as you go down the airway?
can lead to possible airway collapse (emphysema)
Beta 2 is a broncho_______
bronchodilator
Muscarinic 3 receptors are broncho______
bronchoconstriction
Velocity in the respitratory zone is _____ because of the increase in cross sectional area
slow
What are the cell types in alveoli?
- Type I cell (simple squamous cell)
- Type II cell (surfactant
- Macrophages
What type of cell produces surfactant?
Type II
What does surfactant do?
decrease surface tension
easier to breath
The typical transit time at rest for an erythrocyte through an alveolar capillary is ______ seconds
0.75 seconds
Gas exchange is usually
complete in _____ seconds
0.25 seconds
What is PAO2?
100 mmHg
What is PACO2?
40 mmHg
What is PaO2 and PaCO2 before the pulmonary capillary?
PaO2 - 40 mmHg
PaCO2 - 45 mmHg
What is PaO2 and PaCO2 after the pulmonary capillary?
PaO2 - 100 mmHg
PaCO2 - 40 mmHg
What are the inspiratory muscles?
– Diaphragm, external intercostals
– Contraction INCREASES the size of the thorax and lungs (causing decreased Palv)
What are the expiratory muscles?
– Internal Intercostals, abdominal
muscles
– Contraction DECREASES the size of the thorax and lungs (causing increased Palv)
Neurons in the _________ control the lower motor neurons of the respiratory muscles
medulla and pons
The ________ is the primary inspiratory muscle
diaphragm
Expiratory muscles ONLY
contract with ________ expiration.
ACTIVE
What is Boyles law?
P1V1 = P2V2
In a sealed container, pressure times volume equals a constant. If pressure increases, volume decreases and vice versa.
For air to ENTER the lungs, the pressure in the alveoli (Palv) must be ______ than atmospheric pressure (Patm)
lower
For air to LEAVE the lungs, the pressure in the alveoli (Palv) must be ________ than atmospheric pressure (Patm)
higher
The chest wall and the lung both wish to recoil apart how…
– Chest outward recoil
– Lung inward recoil (due to
alveoli)
What overcomes the recoil between the lung and chest wall?
intrapleural fluid
What happens when Patm and Pip are equal?
in between breaths
- penumothorax
If PTP is negative…
collapsed lung
Bigger then Palv what occurs?
inspiration
What is the equation for transpulmonary pressure?
PTP = Palv – Pip
The elastic recoil of the lungs favors a __________ in lung volume or compression while the elastic recoil of the chest wall favors an _______ in lung volume or expansion.
decrease
increase
What are the steps of inspiration?
- Inspiratory Muscles contract and the VOLUME of the thorax (and lungs) increases.
- Because volume has increased, the pressure in the lungs (Palv) decreases.
- When Palv < Patm, air flows into the lungs…
a. As air enters the lungs, Palv begins to increase again.
b. Air flow continues until Palv = Patm.
Nearly half of the energy expended for inspiration is stored in…
elastic recoil
What are the steps of expiration?
- In relaxed breathing, it is a passive process due to relaxation of inspiratory muscles
- The thorax (and thus the lungs) decrease in volume.
- Because volume decreases, lung pressure (Palv) increases
- As soon as Palv > Patm, air flows down pressure gradient and
out of the lungs
a. As air leaves the lungs, Palv decreases.
b. When Palv = Patm, air flow stops
What are the two factors that affect pulmonary ventilation?
- lung compliance
- airway resistance
What is the equation for compliance?
Compliance = change Volume/change Pressure
Is the lung more elastic or compliant?
elastic
What is the opposite of compliance?
elasticity
High compliance =
easy stretch
Lungs with lower compliance require a _______ transpulmonary pressure (PTP) to increase volume
larger
What is an obstructive lung disease?
- elastic fibers destroyed
- increase compliance
- deep and slow breathing
What is restrictive lung disease?
- decreased compliance
- shallow and fast breathing
How do people with obstructive lung disease breathe?
deep and slow
How do people with restrictive lung disease breathe?
shallow and fast
Surface Tension Accounts for _________ of Pulmonary Elasticity
Two-Thirds
What is the law of LaPlace?
the relationship between surface tension and radius of an alveolus
If two alveoli are connected and the
surface tension of each is equal, the
pressure in the small alveolus is greater. Because of this, air will flow into the _________ alveolus.
larger from the smaller
What type of alveoli need more surfactant?
smaller alveoli need more surfactant to lower tension and pressure
__________ reduces surface tension and equalizes pressure between alveoli of different sizes.
Surfactant
What does surfactant do to surface tension and compliance?
decrease surface tension
increase compliance
Surfactant production is increased due to…
- hyperinflation of the lungs
- exercise
- Beta-adrenergic agonists
What pathologies are associated with decrease in surfactant?
- Infant Respiratory Distress Syndrome
- Acute Respiratory Distress Syndrome
- Chronic Smoking
What is the equation for airway resistance?
What are the determinants of resistance?
- radius of bronchi
- viscosity of substance
- length of tube
What are the pathologies that increase airway resistance?
obstructive diseases (asthma, empthysema, bronchitis)
If resistance increases, what must happen to the difference in pressure (Patm –Palv) to maintain normal air flow?
difference in pressure must increase
What causes bronchodilation?
- EPI on B2
- decreased O2
- increased CO2
What causes bronchoconstriction?
- ACH on M
- increased O2
- decreased CO2
- histamine
What is the average tidal volume?
500 mL
What is the table for lung capacities?
What is the graph for lung capacities?
What is residual volume?
cannot breathe this out (always there)
What is anatomic dead space?
amount of air that remains in conducting zone
What is physiologic dead space?
anatomic DS + alveolar DS
What is the equation for minute/pulmonary ventilation?
Tidal volume (ml/breath) X Respiration Rate (breaths/minute)
What is the equation for alveolar ventilation?
(Tidal volume – Dead Space Volume) X Respiration Rate
Is it better to breathe fast and shallow or slow and deep?
It is better to breathe deeper
instead of faster as deeper
breaths get more air into the
respiratory zone for gas exchange!
What is the amout of air in the conducting zone (anatomic dead space)?
150 mL
What is a normal respiratory rate?
12-20 breaths/minute
What is forced vital capacity (FVC)?
Volume of air forcibly expired
after maximal inhalation. ~5 L
What is forced expiration volume (FEV1)?
Fraction of FVC expired during the first second.
What is the normal FEV1/FVC?
80%
What disease type is FEV1/FVC less than 80%?
obstructive lung disease
What is eupnea?
normal quiet breathing
What is hyperpnea?
Increased rate or volume due to
higher metabolism
What is hyperventilation?
Increased rate or volume w/o
increased metabolism
What is wrong with obstructive diseases?
increased airway resistance
What is wrong with restrictive diseases?
decreased lung compliance
What are the examples of obstructive diseases?
- asthma
- emphysema
- bronchitis
- cystic fibrosis
Obstructive diseases primarily impacts _________. Individuals with obstructive diseases will breathe _____________________.
expiration
slow and deep
Restrictive diseases primarily impacts __________. Individuals with restrictive diseases will breathe _____________________.
inspiration
fast and shallow
What are treatment options for atopic asthma (IgE mediated)?
- Quick-relief medications: β2
agonists, anticholinergic agents, etc. - Long-term medications: inhaled corticosteroids, long-acting bronchodilators.
What is atopic asthma?
An allergen leads to an inflammatory response that causes bronchospasms that obstruct airflow. Chronic inflammation can lead to impaired mucociliary response, edema and increased airway responsiveness
What is nonatopic asthma?
can occur with respiratory infections, exercise, hyperventilation, cold air, inhaled irritants, aspirin and other NSAIDS
What is cystic fibrosis?
Autosomal recessive disorder resulting in defective chloride ion transport (mutation in CFTR ion channel) that results in an abnormally thick mucus that obstructs airways.
What are the treatments for cystic fibrosis?
- Antibiotics
- Chest Physical Therapy (percussion and postural drainage)
- Mucolytic agents
- Pancreatic enzyme replacement
What is emphysema?
Destruction of elastic fibers & enlargement of airspaces due to destruction of airspace walls.
What does emphysema due to resistance, elasticity, and compliance?
increased resistance
decrased elasticity
increased compliance
What enzyme inactivates elastase before it can destory elastic fibers in the lungs?
α1-anti-trypsin inactivates elastase
What are the symptoms of restrictive respiratory disease?
- Increased respiratory rate
- Chronic cough (dry, non-productive)
- Polycythemia (increased RBC) due to hypoxia
