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Medicine yr1 > RESP-pulmonary ventilation and breathing > Flashcards

RESP-pulmonary ventilation and breathing Flashcards

1
Q

what are the 4 types of pressure?

A
  • atmospheric pressure
  • trans-pulmonary pressure
  • intra-pleural pressure
  • pulmonary/ intra-alveolar pressure
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2
Q

what is atmospheric pressure?

A

pressure of air outside the body

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3
Q

what is trans-pulmonary pressure?

A

the difference in intrapulmonary and intra-pleural pressure

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4
Q

should trans-pulmonary pressure always be positive or negative?

A

positive

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5
Q

what is intra-pleural pressure?

A

pressure intra-pleural space (between parietal and visceral pleura)

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6
Q

should intra-pleural pressure always be positive or negative?

A

negative

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7
Q

what happens to intra-pleural pressure upon inspiration?

A

becomes more negative

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8
Q

what is pulmonary/ intra-alveolar pressure?

A

pressure inside the lungs/ alveoli

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9
Q

what happens to the pressure in inspiration?

A

intrapulmonary pressure < atmospheric pressure

=air moves into lungs

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10
Q

what happens to the pressure in expiration?

A

intrapulmonary pressure > atmospheric pressure

=air moves out of lungs

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11
Q

which pressure should always be the the lowest value?

A

intra-pleural pressure

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12
Q

how does air always move?

A

-down pressure gradient (from high to low)

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13
Q

what is breathing also called?

A

pulmonary ventilation

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14
Q

what is inspiration?

A

breathing in

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15
Q

what is expiration?

A

breathing out

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16
Q

how is breathing accomplished?

A

by changing the lung/ thoracic cavity volume

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17
Q

what are the requirements of the thorax for breathing?

A
  • must be rigid enough for protection

- yet flexible enough to act as bellows for breathing

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18
Q

is inspiration active or passive?

A

active process

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19
Q

how is inspiration initiated?

A

by the respiratory control centre in the medulla oblongata

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20
Q

what does the activation of the medulla do in inspiration?

A
  • causes contraction of diaphragm and external intercostal muscles
  • Leads to an expansion of the thoracic cavity and a decrease in the pleural space pressure
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21
Q

is expiration an active or passive process?

A

passive-due to elastic recoil of lungs

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22
Q

are there any exceptions to expiration being passive?

A

-If a lot of air has to be removed quickly (eg. during exercise) the internal intercostal muscles and abdominal muscles contract and accelerate expiration by raising pleural pressure

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23
Q

how do pressure differences between the 2 ends of the conducting zone occur?

A

due to changing lung volumes

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24
Q

what are 3 important properties of lungs?

A
  • compliance
  • elasticity
  • surface tension
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25
Q

what is recoil pressure?

A

measure of elastic forces in the lungs that tend to collapse the lungs at each instant of respiration

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26
Q

describe the mechanism of inhalation

A
  • the volume of the thoracic cavity increases
  • ->vertically when diaphragm contracts and flattens
  • ->laterally when ICs raise ribs
  • vol increases/ intrapulmonary pressure decreases
  • air moves into lungs
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27
Q

when does inspiration begin?

A

inspiration begins as the diaphragm contracts

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28
Q

which muscle is the strongest muscle of exhalation?

A

rectus abdominis

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29
Q

describe the mechanism of exhalation

A
  • the volume of the thoracic decreases..
  • ->vertically when diaphragm recoils and domes
  • ->laterally when ICs passively relax (or muscles of forces expiration lower ribs)
  • vol decreases/ intrapulmonary pressure increases
  • air moves out of lungs
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30
Q

name the muscles of forced inspiration

A
  • sternocleidomastoid
  • scalenes
  • pectoralis major
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31
Q

name the muscles of quiet inspiration

A
  • external ICs

- diaphragm

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32
Q

name the muscles of forced expiration

A
  • internal ICs
  • external oblique
  • internal oblique
  • transverse abdominis
  • rectus abdominis (strongest)
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33
Q

does quiet respiration require muscular effort? why?

A

no

-it is achieved by ribs and diaphragm returning to their resting state

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34
Q

what are the roles of the conducting airways?

A
  • humidify air
  • warm air
  • secrete mucous
  • protect lungs from air particles
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35
Q

which structures of the respiratory system make up the conducting airways?

A
  • trachea
  • primary bronchus
  • secondary bronchus
  • tertiary bronchus
  • terminal bronchus
  • conducting bronchiole
  • terminal bronchiole
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36
Q

which structure of the conducting airway is the first without any cartilage?

A

conducting bronchiole

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37
Q

which structures make up the respiratory airways?

A
  • respiratory bronchiole

- alveoli

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38
Q

what are the roles of the respiratory airways?

A
  • gas exchange

- surfactant secretion

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39
Q

inspiration begins as…

A-the lungs contract
B-the external IC muscles contract 
C-the lateral volume of the thoracic cage decreases
D-the diaphragm relaxes and domes 
E-the diaphragm contracts and flattens
A

E

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40
Q

during inspiration…

A-atmospheric pressure< intrapulmonary pressure
B-intrapleural pressure>intrapulmonary pressure
C-transpulmonary pressure< atmospheric pressure
D-atmospheric pressure = intrapulmonary pressure
E-intrapulmonary pressure = intrapleural pressure

A

C

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41
Q

which of the following is NOT a muscle of exhalation?

A-sternocleidomastoid
B-internal oblique
C-external oblique
D-transversus abdominis
E-internal ICs
A

A

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42
Q

which of the following is the only one which does NOT require muscular effort?

A-quiet inhalation 
B-quiet exhalation
C-forced inhalation 
D-forced exhalation 
E-they all require it
A

B

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43
Q

what is tidal volume (TV)?

A

the amount of air in a single inspiration or expiration

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44
Q

what is functional residual capacity (FRC)?

A

the volume of air that remains in the lungs at the end of normal respiration

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45
Q

what is vital capacity (VC)?

A

the volume of air that can be exhaled after a maximal inspiration

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46
Q

what is the name for the amount of air remaining in the lungs after maximal expiration?

A

residual volume (RV)

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47
Q

what is the name for the maximum volume of air in the lungs after a maximal inspiration?

A

total lung capacity (TLC)

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48
Q

what is the typical tidal volume (TV) value?

A

500ml

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49
Q

what is the typical VC value?

A

4800ml

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50
Q

what is the typical FRC value?

A

2400ml

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51
Q

what is the typical RV value?

A

1200ml

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52
Q

how many lung volumes are there?

A

4

53
Q

which lung volumes can spirometry measure?

A
  • inspiratory reserve volume
  • tidal volume
  • expiratory reserve volume
54
Q

how many lung capacities are there?

A

4

55
Q

what are lung capacities?

A

combinations of lung volumes

56
Q

what is the most important lung capacity measurment?

A

VC

57
Q

what is forced vital capacity (FVC)?

A

volume of air that can be forcibly blown out after full inspiration (litres)

58
Q

what is forced expiratory volume (FEV1)?

A

volume of air that can be forcibly blown out-in one second-after full inspiration (litres)

59
Q

what is laminar flow?

A

the smooth passage of air out of the airways

60
Q

what are the (FEV1 and FVC) spirometry results of a healthy person?

A
  • FEV1 % predicted > 80%
  • FVC % predicted > 80%

FEV1:FVC ratio= 0.7-0.8

61
Q

describe how the flow-volume loop appears in a healthy person

A

1-exhalation begins as sharp peak (air leaving trachea)

2-exhalation continues by the vol of air leaving at a steadily decreasing rate (air leaving bronchi)

3-negative loop backwards is the person inspiring air

62
Q

what are the 2 types of respiratory disease detected by spirometry?

A
  • obstructive

- restrictive

63
Q

what are the spirometry values for FEV1 and FVC characteristic with obstructive disease?

A

FEV1: FVC ratio < 0.7

-FEV1 % and FVC % not required if ratio less than 0.7

64
Q

what is the shape of the time-flow loop of a patient who suffers from obstructive disease?

A
  • scalloped shape
  • ->difficult for air to leave the airways because of obstruction
  • ->but eventually all air leaves
65
Q

what are the spirometry values for FEV1 and FVC characteristic with restrictive disease?

A

FEV1 : FVC ratio =normal (0.7-0.8)

FEV1 % predicted reduced (<80%)

FVC 5 predicted reduced (<80%)

(both reduced so ratio not affected)

66
Q

what is the shape of the time-flow loop of a patient who suffers from restrictive disease?

A
  • normal shape but cute short
  • ->not all air leaves airways
  • ->lung tissue is too stiff or ribs/ muscles are ineffective and too weak for forced expiration
67
Q

what are the limitations of spirometry?

A
  • dependent on patient cooperation and effort
  • since results are dependent on patient cooperation, lung vol (FVC) can only be underestimated, never overestimated
  • usually repeated at least 3xx to ensure reproducibility, each FVC result within 5% or less than 150ml variation
  • stable asthmatics have normal spirometry between acute exacerbation, limiting spirometry’s usefulness as a diagnostic tool
  • look at flow vol loop to assess quality and effort of the test (not always available in some commercial spirometers)
68
Q

What are some other diagnostic tests for respiratory conditions?

A
  • VO2 max
  • Respiratory muscle strength
  • Diffusion capacity
69
Q

what are some example of people voluntarily controlling their breathing?

A
  • singing
  • speaking
  • yelling
  • holding their breath
70
Q

which part of the brain is involved in voluntarily controlling your breathing?

A

cerebral cortex

71
Q

what is the effect of an increase in body temperature on respiration rate?

A

will involuntarily increase respiration rate

72
Q

what are the 2 groups the medullary centre is split into?

A

-ventral respiratory group (VRG)

-dorsal respiratory group
DRG

73
Q

what is the role of the ventral respiratory group (VRG)?

A
  • inspiration and expiration

- forceful breathing only

74
Q

what is the role of the dorsal respiratory group (DRG)?

A
  • inspiration only

- quiet and forceful breathing

75
Q

what are the 2 types of breathing?

A
  • quiet (normal) breathing

- forceful breathing

76
Q

what is the Pre-Botzinger complex?

A
  • structure in the VRG
  • helps modulate the rhythm of breathing
  • similar to a pacemaker
77
Q

what happens when the DRG activates?

A
  • activates for 2 seconds
  • diaphragm contracts via phrenic nerve (c3-5)
  • external IC muscles contract via IC nerves (T1-T11)

=quiet inspiration

78
Q

what happens when the DRG deactivates?

A
  • deactivates for 3 seconds
  • diaphragm relaxes
  • external IC muscles relax

=quiet (passive) expiration

79
Q

describe the neural control of forced inhalation

A

-DRG activates
(diaphragm contracts/ external IC muscles contract via IC nerves)

-VRG activates
(accessory muscles of inhalation C1-3-sternocleidomastoid, scalene, pectoralis minor contract)

=forceful inhalation

80
Q

describe the neural control of forced exhalation

A

-VRG activates accessory muscles of exhalation

(external oblique, transversus abdominus, rectus abdominis)

and internal IC
(via IC nerves) contract

=forceful exhalation

81
Q

what is the pontine respiratory centre responsible for?

A

modifying the basic rhythm of breathing when exercising, sleeping and speaking

82
Q

when is the pontine respiratory centre active?

A

during any type of respiration

83
Q

what are the 2 centres associated with the pontine respiratory centre?

A
  • apneustic centre

- pneumotaxic centre

84
Q

where is the apneustic centre located?

A

lower pons

85
Q

where is the pneumotaxic centre located?

A

upper pons

86
Q

what is the role of the apneustic centre?

A
  • stimulates inspiratory centres in the medulla
  • sends signals for longer and deeper breaths
  • “apneuses” ->gasps
87
Q

what is the role of the pneumotaxic centre?

A
  • inhibits inspiratory centres in the medulla and the apneustic centre
  • sends signals for shorter and shallower breaths
88
Q

what is the role of mechanoreceptors in influencing neural control?

A

prevent over-inflation of the lungs

89
Q

where in the respiratory system are mechanoreceptors located?

A

located in the bronchi

90
Q

describe the Hering-Brewer reflex.

A

1-stretching causes activation of mechanoreceptors

2-receptors send inhibitory signals to the DRG (inspiration) via the vagus nerve

3-inspiration stops

4-expiration begins, reducing the amount of stretch and deactivates the mechanoreceptors-the vagus nerve no longer inhibits the DRG

5-inspiration allowed to begin (basic negative feedback loop)

91
Q

what is the role of chemoreceptors in influencing neural control?

A

-monitors levels of O2, CO2 and pH and influences respiration accordingly

92
Q

what are the 2 types of chemoreceptors?

A
  • peripheral

- central

93
Q

where are peripheral chemoreceptors located?

A

in the bifurcation of the aorta into the carotid artery and the aortic arch

94
Q

what is the role of peripheral chemoreceptors?

A
  • monitors levels of O2

- modulates respiratory centres (DRG and VRG) via vagus nerve and glossopharyngeal nerve

95
Q

where are central chemoreceptors located?

A

on the surface of the medulla and are exposed to CSF

96
Q

what is the role of central chemoreceptors?

A
  • directly monitors H+
  • indirectly monitors levels of CO2 to modulate respiratory centres (DRG and VRG)
  • CO2 + H2O H2CO3 H+ + HCO3-
97
Q

what are the components of haemoglobin

A
  • protein which contains 4 haem groups

- also contains 4 globin groups

98
Q

what happens to Hb as one O2 molecule binds?

A

Co-operative binding

->binding of 1st O2 molecule causes conformational change making ti easier for the other 3 O2 molecules to bind

99
Q

what is formed as O2 binds to the haem group?

A

oxyhaemoglobin

100
Q

where does o2 bind to Hb and where is it unloaded?

A
  • binds in lungs

- offloads at body tissues

101
Q

which molecule binds to the globin group of Hb?

A

CO2 (x4)

102
Q

what is formed when co2 binds to Hb?

A

carboxyhaemoglobin

103
Q

where does co2 bind to Hb and where is it unloaded?

A
  • binds in body tissues

- offloads in lungs

104
Q

where is the majority of co2 dissolved?

A

the plasma

105
Q

what % co2 is bound to Hb?

A

23%

106
Q

The dissolving of co2 in the blood is in equilibrium. What happens to the equilibrium in the body tissues?

A

the equilibrium shifts right

->to produce more H+ + HCO3-

107
Q

The dissolving of co2 in the blood is in equilibrium. What happens to the equilibrium in the lungs?

A

the equilibrium shifts left

->to produce more CO2 + H2O

108
Q

what is the equation for when co2 reacts with h2o?

A

CO2 +H2OH2CO3H+ + HCO3-

109
Q

what is the chloride shift?

A

when HCO3- leaves the blood cell and enters the plasma, Cl- ions enter the blood cell, to maintain an electrical balance

110
Q

what is the Bohr effect?

A

high concentrations of H+ will cause HbO2 to give up O2

111
Q

what is the Haldane effect?

A

HbO2 reduces the affinity of globin for CO2

CO2 does not bind easily if O2 has already been bound

112
Q

Outline Boyle’s Law.

A

the volume of gas varies inversely with its pressure

113
Q

Outline Dalton’s Law.

A

the total pressure is equal to the sum of partial pressures

114
Q

Outline Henry’s Law.

A

the solubility of a gas in a liquid is dependent upon;

  • > the partial pressures of gas in the air
  • > the solubility coefficient of the gas in the liquid
115
Q

which is more soluble co2 or o2 and what does this mean for O2 diffusion?

A
  • CO2 is more soluble than O2

- >higher p(O2) required for O2 to diffuse

116
Q

why is it necessary that in alveolar air and arterial blood-p(O2) is much higher than p(CO2)?

A

so that p(O2) is able to diffuse into blood

117
Q

Outline Graham’s Law.

A

the rate of diffusion is:

  • > directly proportional to the solubility coefficient of the gas
  • > inversely proportional to the square root of its molecular weight
118
Q

Outline Fick’s Law of Diffusion.

A

the amount of gas diffusing in (unit time) through the resistence of a barrier is:

  • > directly porortional to the SA of the barrier, the diffusion constant (D) and the partial pressure on each side
  • > indirectly proportional to the thickness of the barrier
119
Q

what are the values for p(O2) either?

A

5kPa
or
13kPa

120
Q

what are the values for p(CO2) either?

A

5kPa
or
6kPa

121
Q

what does it mean for the o2-Hb dissociation curve when there is a higher p(O2)?

A
  • more area under the curve
  • Hb has higher affinity for o2
  • O2 will more readily load onto Hb (e.g. in the lungs)
122
Q

what does it mean for the o2-Hb dissociation curve when there is a lower p(O2)?

A
  • less area under the curve
  • eg in respiring tissues
  • Hb has lower affinity for O2
  • o2 more readily unload off Hb and onto respiring tissues
123
Q

At what p(O2) is Hb saturated to 90%?

A

8kPa

124
Q

what is the atmospheric p(O2) when Hb is 90% saturated?

A

13kPa

-means humans can still achieve 90% saturation even if they enter environments in which p(O2) drops by 6kPa

125
Q

which conditions will increase p(O2) value (and therefore decrease affinity for O2 to Hb-shift curve right)?

A
  • acidity (low pH causes o2 to be liberated-Bohr effect
  • high co2-similar effects to low pH
  • increased temp-heat is by-product of metabolic reactions-require more o2, o2 liberated more readily-more kinetic bonds
  • increased 2,3DPG-substance found in RBCs causes o2 to bind less tightly to haem groups (via allosteric binding)
126
Q

what does increased Hb O2 affinity mean for O2 unloading?

A

increased affinity= reduced unloading

127
Q

what does decreased Hb O2 affinity mean for O2 unloading?

A

decreased affinity=increased unloading

128
Q

which factors increase Hb’s O2 affinity?

A
  • low temp
  • low 2,3-DPG
  • low H+ conc (high pH)
  • foetal Hb
129
Q

which factors decrease Hb’s O2 affinity?

A
  • low pH (high H+ conc)
  • high co2
  • high temp
  • high 2,3 DPG

Medicine yr1 (55 decks)

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