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Physiology > Resp - Respiratory Mechanics > Flashcards

Resp - Respiratory Mechanics Flashcards

1
Q

muscles of inspiration

A 
diaphragm (75%)
external intercostals (25%)
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2
Q

accessory inspiration muscles

A

scalenes (raise rib 1/2)

sternocleidomastoid (raise sternum)

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3
Q

muscles of expiration (active)

A

abdominal wall

internal intercostals

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4
Q

causes for difficulty inspiring

A

scar tissue
reduced surfactant
mucous
fluid

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5
Q

causes for difficulty expiring

A

emphysema

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6
Q

point where laminar –> turbulent

A

reynolds # > 2000

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7
Q

conditions where turbulence likely occurs

A

velocity high

radius high

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8
Q

Reynold’s number

A

Re = 2rvd/n

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9
Q

Ohm’s law (airflow)

A

F = delta P/R

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10
Q

Poiseuille’s law

A

R = 8L(viscocity)/pi(radius^4)

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11
Q

Poiseulle’s law take away

A

smaller the airway, greater the R (reduce r by 50% increase R x 16)

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12
Q

site of most airway R (+why)

A

medium sized bronchi

smaller than large (up R) and in series rather than parallel (smaller ones in parallel)

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13
Q

factors increasing resistance

A 
turbulent flow
small radius
lung volume decreasing
bronchial SM contraction
gas density elevated (SCUBA)
forced expiration
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14
Q

causes of bronchoconstriction

A

allergy
mucous, airway collapse
PNS during relaxed state (Ach on muscarinic)
low CO2

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15
Q

causes of bronchodilation

A

SNS

  • Epi (beta-2)
  • CO2 up
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16
Q

forced exhalation

A 
PA drives air out
PA = Pip + P elastic recoil
further from alveoli, less recoil
exhaling air hits R, loses P
EPP
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17
Q

equal pressure point

A

when Pairway = Pip
if Pip > Pairway –> collapse
(EPP @ cartilage for healthy people)

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18
Q

emphysema and forced expiration

A

alveoli have lost elastic recoil

PA is lower, EPP happens closer to alveoli, compression of airway

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19
Q

chronic obstructive pulmonary disease (diseases)

A

asthma
chronic bronchitis
emphysema

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20
Q

emphysema mech

A
  1. irritation –> many macs, release trypsin
    usually alveoli release antitrypsin (but too many macs to fight)
  2. breakdown of alveolar walls
  3. down recoil, collapse smaller airways
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21
Q

pulmonary function tests

A

spirometry
lung vol measurement
diffusion capacity for CO
arterial blood gases

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22
Q

tidal volume (TV)

A

V in or out in quiet resp

~500 ml

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23
Q

inspiratory reserve volume (IRV)

A

extra V can be inspired after quiet inspiration

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24
Q

expiratory reserve volume (ERV)

A

extra V can be expired after quiet expiration

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25
Q

inspiratory capacity (IC)

A

max V in after quiet expiration (TV + IRV)

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26
Q

vital capacity (VC)

A

max V in after max expiration (IRV + TV + ERV)

~ 4800 ml

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27
Q

residual volume (RV)

A

min air remaining in lungs after max expiration

28
Q

functional residual capacity (FRC)

A

V in lungs after quiet expiration (ERV + RV)

29
Q

total lung capacity (TLC)

A

max V lungs can hold (VC + RV) ~6000 ml

30
Q

abnormal spirometry results (obstructive)

A

can’t get air out
RV up
up RV, FRC, TLC
–> slow flow, hyperinflation, down recoil

31
Q

abnormal spirometry results (restricted)

A

cant get air in
TLC down
down VC, RV, FRC, VT
–> up recoil, down V

32
Q

spirogram measurements

A

FVC: (V forcibly blown out after full breath)
FEV1: V forced out in 1 second
FEV1/FVC: proportion

33
Q

normal FVC

A

80%

34
Q

abnormal spirogram (obstructive)

A 
FEV1 down (a lot)
FVC down
FEV1/FVC down (42%)
35
Q

abnormal spirogram (restrictive)

A

FEV1 down
FVC down
FEV1/FVC normal or higher

36
Q

flow volume loop action

A
  1. inhale to TLC
  2. exhale to RV as forcefully and quickly as possible
  3. forcefully inspire to TLC
37
Q

flow volume loop: forced expiration

A

compression of airways from Pip up –> high flow then slow down
early = pt dependent
late = pt independent

38
Q

flow volume loop: forced inspiration

A

muscle force down as V up
lung recoil up as V up
airway R down as V up

39
Q

abnormal flow volume loop (obstructive)

A

scooped
peak is lower but quick
slow expiration flow

40
Q

abnormal flow volume loop (restrictive)

A

witch’s hat

TLC, FVC is lower

41
Q

Diffusion capacity action

A
  1. exhale to RV
  2. inhale gas (w/ small CO) to TLC
  3. hold breath 10 s
  4. measure exhaled gas for CO
42
Q

diffusion capacity (obstructive)

A

hyperinflation and DLCO down –> emphysema
hyperinflation and DLCO normal –> asthma
normal lung volume and DLCO normal –>. chronic bronchitis

43
Q

DLCO results

A

DLCO down in any condition affecting alveolar surface area

lung resection, emphysema

44
Q

diffusion capacity (restrictive)

A

low RV and low DLCO –> scarring diseases

normal (or high) RV and normal DLCO = neuromuscular diseases, kyphosis, scoliosis

45
Q

lung compliance

A

delta V/delta P

46
Q

things that affect compliance

A

apex vs base
inspiration vs expiration (hysteresis)
disease
amount of CT

47
Q

compliance (regional)

A

compliance greatest at base

gravity pulls on alveoli in apex, makes them more expanded

48
Q

compliance (hysteresis)

A

PV curve diff for inspiration and expiration (not linear)

scoop for inspire, bump for expire

49
Q

compliance (disease)

A

low compliance: stiff - pulmonary fibrosis - large transmural P needed to expand
high compliance: low recoil - emphysema

50
Q

elastic recoil relations

A

directly related to stiffness (low compliance)

inversely related to distensibility (high compliance)

51
Q

things affecting elastic recoil

A

elastin/collagen

*alveolar surface tension (2/3)

52
Q

surface tension actions

A

increases recoil
decreases compliance
responsible for diffs in inspiration/expiration curves

53
Q

surface tension relative to size

A

smaller alveoli more likely to collapse than larger

54
Q

LaPlace’s Law

A 
P = 2T/r
T = surface tension
55
Q

DPPC

A 
dipalmitoyl phosphatidylchloline
hydrophilic head (go in fluid)
hydrophobic tail (go in air)
attenuate cohesion (act as detergent)
56
Q

surfactant and alveoli size

A

most effective when DPPC close together –>

small alveoli have lower ST

57
Q

surfactant fxns

A
  1. lower surface tension (increase compliance)
  2. stabilize alveoli
  3. keep alveoli dry (avoid edema)
58
Q

how surfactant keeps alveoli dry

A

ST usually lowers interstitial hydrostatic P (pulls fluid in)
surfactant reduces this

59
Q

neonatal resp distress syndrome mech

A

abnormally low production of surfactant
up ST
collapse alveoli (atelectasis)
hypoxemia

60
Q

neonatal resp distress syndrome Sx

A

cyanosis
pronounced hysteresis
high inflation P to ventilate
pulmonary edema

61
Q

alveoli stabilizing factors

A

elastin/collagen (against overdistension)
surfactant
interdependence (tethering effect)
transmural pressure gradient

62
Q

forces promoting alveolar collapse

A

elasticity (elastin)

alveolar surface tension

63
Q

forces keeping alveoli open

A

transmural P gradient
pulmonary surfactant
alveolar interdependence

64
Q

chest volume equilibrium

A

equilibrium @ ~70% TLC
< 70: recoil force out
> 70: recoil force in

65
Q

lung/chest combined equilibrium volume

A

chest compressed below equilibrium
lung expanded above
chest force out is equal to lung force in
occurs @ FRC

Physiology (22 decks)

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