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Physiology 2nd Midterm > Respiratory 1 > Flashcards

Respiratory 1 Flashcards

1
Q

Which structures ar involved in the conducting zone

A

Trachea
Bronchi
Bronchioles
Terminal bronchioles

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2
Q

Which structures ar involved in the respiratory zone

A

Respiratory bronchioles
Alveolar ducts
Alveolar sacs

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3
Q

Difference between conducting zone and respiratory zone

A

Conducting zone : only a passage way for air (no gas exchange)

Respiratory zone: gas exchange occurs

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4
Q

Types of alveolar cells

A

Type 1 alveolar cells

Type 2 alveolar cells (septal cells)

Alveolar dust cells

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5
Q

What are type 1 alveolar cells

A

Simple squamous cells where gas exchange occurs

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6
Q

What are type 2 alveolar cells

A

Septal cells that secrete surfactant

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7
Q

What are alveolar dust cells ?

A

Macrophages that remove debris

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8
Q

True or false
the respiratory membrane is extremely thin

A

True

( < 1/2 μm)

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9
Q

Purpose of surfactant

A

Reduces surface tension to keep alveoli open and prevents them from collapsing during exhalation.

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10
Q

Don’t know if this is important so just read

A

Next

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11
Q

Functions of respiratory system

A

Acid-base balance
Water and heat balance
Phonation
Pulmonary defense
Metabolism
Gas exchange (ventilation)

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12
Q

How does the respiratory system help maintain acid-base balance

A

By regulating arterial CO2 level and eventually pH

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13
Q

How does the respiratory system help maintain water and heat balance

A

Water loss through saturation of inhaled air
Heat loss through respiratory water evaporation

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14
Q

How does the respiratory system help with phonation

A

Production of sounds occur by the movement of air through the vocal cords

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15
Q

How does the respiratory system aid in pulmonary defense

A

Filtration of inspired air and removal of particulate matter such as dust, pollen, fungal spores, micro organisms, etc.

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16
Q

What is the respiratory system‘s role in metabolism

A

Formation and release of substances such as pulmonary surfactant and repair of alveolar surface in response to injury

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17
Q

Read

A
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18
Q

What is meant by ventilation

A

Movement of gas into and out of the lungs

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19
Q

What is meant by alveolar gas exchange

A

Diffusion of O2 from alveoli to blood
Diffusion of CO2 from blood to alveoli

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20
Q

What is meant by blood gas transport

A

Gas is present in the blood either in dissolved form, bound to hemoglobin or as other chemical forms

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21
Q

What is meant by cellular gas exchange

A

Diffusion of O2 from blood to cells
Diffusion of CO2 from cells to blood

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22
Q

Regulation of ventilation is done by ________________.

A

Central nervous system CNS

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23
Q

Appreciate the diaphragm in this picture

A

During inspiration, the diaphragm contracts and moves downward providing more space for the lungs to expand

During expiration, the diaphragm relaxes and moves upward

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24
Q

Accessory muscles of inspiration for forceful inhalation

A

Sternocleidomastoid
Scalene
Pectoralis major

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25
Q

Principle (main) muscles of inspiration for quiet breathing

A

External intercostals
Interchondral part of internal intercostals
Diaphragm

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26
Q

Muscles of expiration for active breathing (forceful exhalation)

A

Internal intercostals (except interchondral part)
Abdominals
Quadratus lumborum

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27
Q

Pressures involved in breathing are :

A

Airway pressure (P aw)
Alveolar pressure (PA , P alv )
Intrapleural pressure (P pl)

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28
Q

What is the visceral pleura

A

Delicate serous membrane that covers the surface of each lung and dips into the fissures between the lobes

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29
Q

What is the parietal pleura

A

Outer membrane which is attached to the inner surface of the thoracic cavity. It also separates the pleural cavity from the mediastinum

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30
Q

What is pneumothorax

A

Abnormal collection of air in the pleural space

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31
Q

What causes pneumothorax and what is its effect on the lungs

A

Cause: Results from rupture or puncture of the lung or chest wall

Effect on lung: lung elastic recoil causes collapse of the lung

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32
Q

Airflow (Q) in and out of the lungs depends on:

A
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33
Q

What causes air to move in and out of the lungs

A

Changes in alveolar pressure

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34
Q

What happens if alveolar pressure (Palv) is LESS than atmospheric pressure (Patm)

Palv < Patm

A

Air flows INTO the lungs = INSPIRATION

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35
Q

What happens if alveolar pressure (Palv) is MORE than atmospheric pressure (Patm)

Palv > Patm

A

Air flows out of the lungs = EXPIRATION

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36
Q

What happens if alveolar pressure (Palv) is EQUAL TO atmospheric pressure (Patm)

Palv = Patm

A

No pressure gradient so no air is moving in or out of lungs (no air flow)

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37
Q

Explain the pressure change during inspiration

A
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38
Q

Explain the pressure change during expiration

A
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39
Q

What happens to pleural pressure during inspiration

A

Becomes MORE negative

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40
Q

What happens to pleural pressure during expiration

A

Becomes LESS negative

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41
Q

What is the relationship between air flow (Q) and airway resistance (Raw)

A

Inversely proportional

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42
Q

Airway resistance (Raw) is determined by which law

A

Poiseuille law

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43
Q

Relationship between the airway resistance (Raw) and air viscosity ?

A

Directly proportional

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44
Q

Relationship between the airway resistance (Raw) and airway length ?

A

Directly proportional

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45
Q

Relationship between the airway resistance (Raw) and airway radius ?

A

Inversely proportional (to the 4th power)

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46
Q

Factors affecting radius of airways

A

Long volume
Airway smooth muscle tone
Airway inflammation
Airway mucous secretions

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47
Q

How does lung volume affect the radius/resistance of airways (bronchioles and small airway diameter)

A
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48
Q

How does the ANS control the diameter of the bronchioles and affect the radius of airways ?

A
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49
Q

Effect of parasympathetic cholinergic fibers on airway radius

A
  • smooth muscle constriction
  • increased mucus secretion

= high airway resistance ( high Raw)

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50
Q

Effect of sympathetic adrenergic fibers on airway radius

A
  • smooth muscle relaxation
  • inhibition of mucus secretion

= decrease airway resistance (Low Raw)

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51
Q

How does the sympathetic adrenergic fibers inhibit mucus secretion

A

Through action on bronchial B2 adrenergic receptors

52
Q

Asthmatic patient gets inhaler / nebulaizer.
Should it contain cholinergic or anti-cholinergic drugs?

A

anti-cholinergic drugs

(Because cholinergic increase mucus secretion)

53
Q

Asthmatic patient gets inhaler / nebulaizer.
Should it contain B2 adrengeric receptor agonist or B2 adrenergic receptor antagonist?

A

B2 adrenergic receptor AGONIST

54
Q

Local irritants can cause an increase in inflammatory mediators like:

A
55
Q

Effect of inflammatory mediators on airway radius and airway resistance

A
  • Constriction of bronchioles
  • obstruction of airways

= INCREASE in airway resistance due to decrease in airway radius

56
Q

Diseases that cause airway narrowing are called

A

Obstructive pulmonary diseases

57
Q

Obstructive pulmonary diseases

A

Diseases that cause airway narrowing

58
Q

How does obstructive airway diseases effect airway resistance

A

Increases airway resistance (Raw) due to narrowing of airways

59
Q

Name some diseases that affect small airways

A

Asthma
Emphysema
Bronchitis

(Hint: BAE)

60
Q

Name some diseases that effect large airways

A

Trauma
Infectious diseases
Congenital tracheobronchial abnormalities
Inflammatory diseases
Neoplasm

(Hint: TICIN)

61
Q

What are the three basic components of the elastic properties of the lungs

A
  1. Compliance / distensibility
  2. Stiffness
  3. Elasticity
62
Q

What is meant by compliance and dispensability of the lung

A

The ease with which of the lungs can be stretched or inflated

63
Q

What is meant by stiffness

A

Resistance to stretch or inflation

64
Q

What is meant by elasticity

A

The ability of a stretched or inflated Lunk to return to its resting volume (functional residual capacity FCR)

65
Q

Difference between compliance and elasticity of

A

Compliance reflects the ability to change the shape of the structure such as stretching,

whereas elasticity reflects resistance to the change in shape ( the ability to return to the normal state )

66
Q

Lung compliance

A

The change in lung volume resulting from 1 cm H2O change in the descending pressure of the lung

67
Q

Formula for lung compliance

A
68
Q

Compliance of a normal human lung is about:

A

0.2 L/cm H2O

69
Q

Lung compliance decreases in what type of disease + provide example

A

Restrictive pulmonary disease
Example: fibrosis

70
Q

Lung compliance increases in what type of disease + provide example

A

Obstructive pulmonary disease with air trapping
Example : emphysema

71
Q

Describe the lung compliance for stiff lung

A

Low lung compliance

72
Q

Describe the lung compliance for distensible lung

A

High lung compliance

73
Q

Understand this graph

A

The higher the compliance = the greater the total lung capacity TLC

The lower the compliance = the lesser the total lung capacity TLC

Fibrosis = restrictive pulmonary disease = low compliance

Emphysema = obstructive pulmonary disease = high compliance

74
Q

Effect of surface tension on alveoli

A

High surface tension causes alveoli to collapse since fluid molecules are attracted and pulled closer together, closing off the alveoli

75
Q

What is pulmonary surfactant

A

Phospholipoprotein formed by type 2 alveolar cells

76
Q

What is the main lipid components of surfactant

A

Dipalmitoylphosphatidylcholine DPPC

77
Q

Purpose of pulmonary surfactant

A

Reduces the surface tension by adsorbing (NOT ABSORBING) to the air-water interface of alveoli, with protein (hydrophilic heads) in the water and the lipid (hydrophobic tails) facing the air

78
Q

By reducing surface tension, surfactant functions to:

A
79
Q

What is neonatal respiratory distress syndrome

A
80
Q

What two complications can occur as a result of immature lungs in premature neonates ?

A

Pulmonary edema
Atelectasis (collapse of lung)

81
Q

What are mothers who are expected to give birth prematurely given and why?

A

They are given Glucocorticoid injections (Betamethasone)

To stimulate surfactant formation and improve lung function

82
Q

What is tidal volume (TV or VT)

A

Volume inspired or expired during quiet breathing

83
Q

What is inspiratory reserved volume IRV

A

Maximum air inhaled from end of normal tidal inspiration

84
Q

What is expiratory reserved volume ERV

A

Maximum air exhaled from end of normal tidal expiration

85
Q

What is residual volume RV

A

Air remaining at end of maximum expiration

86
Q

Can residual volume RV be measured by spirometry

A

NO

87
Q

How can we measure residual volume

A

Helium dilution method
Nitrogen washout
Whole body plethysmography

88
Q

What is total lung capacity TLC

A

Air in the lungs after a maximum inspiration

89
Q

What is vital capacity VC

A

Air that can be exhaled after maximum inspiration

90
Q

What is inspiratory capacity IC

A

Maximum air that can be inhaled from the end of normal expiration

91
Q

What is functional residual capacity FRC

A

Volume of air remaining in the lungs at the end of normal expiration

92
Q

Normal tidal volume TV

A

0.5 L

93
Q

Normal inspiratory reserved volume IRV

A

3.0 L

94
Q

Normal expiratory reserved volume ERV

A

1.3 L

95
Q

Normal residual volume RV

A

1.2 L

96
Q

Normal inspiratory capacity IC

A

3.5 L

97
Q

Normal functional residual capacity FRC

A

2.5 L

98
Q

Normal vital capacity VC

A

4.8 L

99
Q

Normal total lung capacity TLC

A

6.0 L

100
Q

What is the IRV

A

IRV = IC - VT = 2.3 - 0.4 = 1.9 L

101
Q

What is ERV

A

ERV = TLC - IC - RV = 4 - 2.3 - 0.8 = 0.9 L

102
Q

What is VC (or IVC)

A

VC = TLC - RV = 4 - 0.8 = 3.2 L

103
Q

What is FRC

A

FRC = TLC - IC = 4 - 2.3 = 1.7 L

104
Q

What does it mean if all lung volumes and capacities are BELOW normal range ?

A

Lung have smaller size = Restrictive pulmonary disease (ex: fibrosis)

105
Q

We can assess restrictive pulmonary disease using spirometry that will show values that are all below average ,

But how can we assess obstructive pulmonary disease?

A

FEV1/FVC ratio

106
Q

How is the FEV1/FVC ratio taken?

A

The subject takes a deep breath and blows out forcefully into a vitalograph that measures the volume exhaled per second

Normal subject can blow out most of his vital capacity VC ( >75% of VC) in the first second

Patient with obstruction cannot because of narrowing of his airways

107
Q

If the FEV1/FVC ratio is equal or above 0.75 

A

Normal

108
Q

If the FEV1/FVC ratio is less than 0.75

A

Obstructive pulmonary disease

109
Q

What is FEV1

A

Forced expired volume in the first second

110
Q

What is FVC

A

Forced vital capacity is the total volume of air exhaled in the maneuver

111
Q

Difference in pathophysiology of obstructive and restrictive pulmonary diseases

A

Obstructive pathophysiology:
Limitation of airflow due to increased airway resistance causing partial or complete obstruction

Restrictive pathophysiology:
Reduce expansion of lungs decreasing all lung volumes

112
Q

Examples of obstructive pulmonary disease

A

Asthma
Bronchitis
Emphysema

(Hint: BAE)

113
Q

Examples of restrictive pulmonary diseases

A

Fibrosis
pneumonia
asbestosis
pleural effusion

(Hint: FAPP)

114
Q

Compare total long capacity TLC in both obstructive and restrictive pulmonary diseases

A

Obstructive: TLC is normal or high

Restrictive: TLC is low ( all lung volumes are low)

115
Q

Compare FEV1/FVC ratio between obstructive and restrictive pulmonary diseases

A

Obstructive:
FEV1/FVC : LESS than 0.75

Restrictive:
FEV1/FVC : EQUAL or MORE than 0.75

116
Q

Compare lung compliance between obstructive and restrictive pulmonary diseases

A

Obstructive: high lung compliance
Restrictive: low lung compliance

117
Q

What is physiologic dead space VD (wasted ventilation)

A

The volume of air that enters the lungs but does not participate in gas exchange

118
Q

Two types of dead space

A

Anatomic dead space
Alveolar dead space

119
Q

What is anatomic dead space

A

The volume of air in the conducting airways including the nose/mouth, pharynx, trachea, bronchi and bronchioles which does not participate in gas exchange

120
Q

What is alveolar dead space

A

The volume of air in the alveoli that are ventilated but not perfused

121
Q

How to calculate physiologic dead space

A

Anatomic dead space + alveolar dead space

122
Q

What is minute ventilation VE

A

Volume of air entering or leaving the nose/mouth per minute

123
Q

How to calculate minute ventilation

A

Tidal volume TV ( ml) x respiratory rate (breaths per minute)

VE = TV x RR

124
Q

Unit of minute ventilation

A

Ml/min

125
Q

What is alveolar ventilation VA

A

The volume of air that reaches the alveoli per minute and contributes to gas exchange (Excluding dead space volume VD)

126
Q

How to calculate alveolar ventilation

A

VA = (Tidal volume - dead space) x respiratory rate

VA = (TV-VD) x RR

Unit: ml/min

Physiology 2nd Midterm (7 decks)

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