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Physiology > Respiratory > Flashcards

Respiratory Flashcards

1
Q

tidal volume

A

volume of air moving in or out of the lung in 1 breath

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2
Q

inhalation reserve volume

A

additional volume of air which can be inhaled after a quiet inhalation

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3
Q

expiratory reserve volume

A

additional volume of air which can be inhaled after a quiet inhalation

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4
Q

vital capacity

A

sum of the tidal volume of air that can be exhaled after a quiet expiration

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5
Q

residual volume

A

volume of air left in the lungs after a full expiration

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6
Q

functional residual capacity

A

sum of the residual volume and the expiratory reserve volume

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7
Q

total lung capacity

A

sum of the residual volume and the vital capacity

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8
Q

minute volume =

A

tidal volume x respiration rate

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9
Q

airway resistance =

A

1/conductance

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10
Q

air flow rate =

A

pressure gradient / resistance to flow

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11
Q

relationship between airflow and alveolar pressure

A

airflow is proportional to alveolar pressure

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12
Q

lung compliance =

A

increment in volume between any 2 positions when airflow has stopped / intrapleural pressure increment

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13
Q

what is intra pleural pressure required for

A

to overcome airway resistance and elastic recoil of the lung

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14
Q

what is needed to overcome airway resistance when there is no airflow

A

no pressure

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15
Q

Describe expiration and inspiration in relation to pressures in the lungs

A

At the end of expiration and end of inspiration, intrapleural pressure is required to balance the elastic recoil only, and alveolar pressure is then equal to atmospheric pressure.
Intrapleural pressure is more negative at the end of inspiration because the elastic tissue in the lungs is more stretched than at the end of expiration

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16
Q

what is the elastic property of the lungs conferred by

A

fibres of elastin in the alveolar walls and by the surface tension in the alveoli

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17
Q

what reduces surface tension

A

surfactant secreted by type 2 pneumocytes
compliance is increased

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18
Q

normal values for vital capacity, tidal volume and functional residual capacity

A

VC = 4-6L
TL = 0.5L
FRC = 2-3L

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19
Q

what factors affect lung compliance

A

surface tension and elastin fibres of alveolar wall

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20
Q

describe a compliance curve in hysteresis

A

curve moved to right

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21
Q

what is hysteresis

A

difference btween the transpulmonary pressure of inhalation (increasing volume) and the pressure of exhalation (decreasing volume)

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22
Q

air way resistance equation

A

= pressure in alveoli /Flow

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23
Q

what holds airways open

A

outward tension by alveolar walls

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24
Q

Non specific immune mechanisms in the respiratory tract

A

mucociliary escalator
coughing
alveolar macrophages
lympatics

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25
Q

effects of obstructive disease on lung volumes

A

Very decreased FEV1
Decreased FVC
decreased FEV1/FVC ratio
airway resistance increases

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26
Q

effects of obstructive disease on lung volumes

A

decreased FEV1
Decreased FVC
same FEV1/FVC ratio
decreased compliance

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27
Q

Regulation of the pulmonary vasculature and glands by the autonomic nervous system

A

parasympathetic - muscarinic; contracts smooth muscle, causes mucus gland secretion
sympathetic
-alpha - constricts blood vessels
-beta2 relaxes respiratory smooth muscle

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28
Q

what is bronchial asthma

A

a chronic inflammatory condition in which there is recurrent reversibly airway obstruction in response to irritant stimuli that are too weak to affect non-asthmatics

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29
Q

what is asthma characterised by

A

episodic, reversible airway obstruction
marked airway inflammation

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30
Q

types of asthma

A

extrinsic -> associated with specific allergic reactions
intrinsic -> not associated with a known allergen

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31
Q

hypersensitivity and IgE and asthma

A
  1. mast cell sensitisation - 1st exposure to Ag causes the production of specific IgE Abs which attach to surface of tissue mast cells and blood basophils
  2. mast cell degranulation - subsequent exposure to Ag results in binding to surface-bound IgE molecules. sensitised mast cells are stimulated to release granules containing histamine, leukotrienes, prostaglandins and other potent chemical mediators
32
Q

immediate phase components of asthma

A

Ag -> IgE -> Mast Cell -> release histamine, prostaglandin, leukotrienes, Interleukins -> Increased vascular permeability, mucous production and bronchoconstriction

33
Q

delayed phase components of asthma

A

incr vascular permeability -> immune cell infiltration -> cytokine release -> inflammation -> reduced airflow, airway hyperreactivity, impaired mucocilliary clearance, edema, airway injury and remodelling

34
Q

2 main classes of drugs used to treat asthma

A

bronchodilators and anti-inflammatory drugs

35
Q

describe bronchodilators and asthma

A

reverse bronchoconstriction; reduce AWR; treat wheeze
eg B2 adrenoreceptor agonists, mucscarinsic
short acting eg salbutamol and long acting salmeterol

36
Q

describe muscarinic receptor antagonists and asthma

A

second-line drugs
SAMAs- short-acting ipratropium bromide
LAMAs- longer-acting ipratropium bromide
bronchodilation; inhibits excess mucus secretion; increases mucociliary clearance of bronchial secretions, no effect on late inflammatory stage

37
Q

cysteinyl-leukotriene synthesis inhibitors and receptor antagonists

A

Zileuton
prevent aspirin-sensitive and exercise-induced asthma
decrease immediate and delayed responses
action is additive with B2-adrenoreceptors agonist

38
Q

anti-inflammatory drugs and asthma

A

relieve bronchial inflammation and/or prevent further inflammation
steroids - Glucocorticoids. may have direct inhibitory actions on several inflammatory cells implicated in pulmonary and airway diseases
non steroids - Xanthines (immunomodulatory effects)

39
Q

pathophysiology of COPD

A
  1. irritant eg smoke + alpha1 antitrypsin deficiency->breakdown of elastin in CT of lungs -> emphysema -> AW obstruction, airway trapping, dyspnea -> abnormal ventilation:perfusion ratio, hypoxemia, hypoventilation
  2. irritant eg smoke->continual bronchial irritation/inflammation-> chronic bronchitis-> same effects
40
Q

mechanism of COPD

A

-irritant activates macrophages and epithelial cells to release chemotactic factors that recruit neutrophils and CD8 cells
-these cells release factors that activate fibroblasts then abnormal repair processes and bronchiolar fibrosis
-imbalance in proteases and anti-proteases-> alveolar wall destruction
-proteases also causes mucous release

41
Q

characteristics and long term control of mild COPD

A

FEV1 greater than 80% predicted
short acting bronchodilator when needed

42
Q

characteristics and long term control of moderate COPD

A

FEV1 50-80% predicted
regular treatment with one or more bronchodilators
inhaled glucocorticosteroid

43
Q

characteristics and long term control of severe COPD

A

FEV1 less than 30% of predicted
same as moderate and also antibiotics for acute exacerbations by increased secretions; long term oxygen therapy

44
Q

normal PaO2

A

95mmHg, 12.7kPa

45
Q

normal PaCO2

A

40mmHg, 5.4kPa

46
Q

normal venous O2

A

40mmHg, 5.4kPa

47
Q

normal venous CO2

A

46mmHg, 6.1kPa

48
Q

normal alveolar O2

A

100mmHg, 13.3kPa

49
Q

normal alveolar CO2

A

40mmHg, 5.4kPa

50
Q

alveolar minute volume =

A

=(tidal volume - dead space) x respiratory rate

51
Q

describe haemoglobin

A

prophrin ring, haem and globin

52
Q

Bohr shift to right

A

increased PCO2, temp, H+ and 2,3 diphosphoglycerate

53
Q

oxygen-dissociation graph for anaemia

A

lower and more to right

54
Q

fick principle

A

oxygen consumption = arteriovenous difference x cardiac output

55
Q

define hypoxia

A

low PaO2

56
Q

causes of hypoxia

A

anaemic - low Hb conc
stagnant - low blood flow
historic - deficiency of tissue utilisation

57
Q

what defends H+ concentration

A

buffers, respiratory regulation, renal regulation
HA <-> H+ + A-

58
Q

what pH is acidosis

A

<7.35

59
Q

what pH is alkalosis

A

> 7.45

60
Q

what is respiratory acidosis

A

retention of carbonic acid - increases pCO2 - may be acute or chronic

61
Q

what is non-respiratory (metabolic) acidosis

A

increased in non-carbonic acids - decreases pCO2 and HCO3-

62
Q

minute volumes at rest vs maximal exercise

A

rest: 500mls x 12 breaths = 6Lmin-1
exercise: 3500mls x 60 breaths = 200Lmin-1

63
Q

what is dead space

A

airways that are cartilaginous/parts of respiratory tree not participating in gas exchange

64
Q

alveolar ventilation

A

amount of air reaching alveoli per minute
=(Tv - Td) x RR

65
Q

alveolar ventilation in shallow breathing vs deep breathing

A

shallow: 150-150 x 40 = 0
deep 1000-150 x 6 = 5100
minute ventilation stays the same

66
Q

respiratory exercise centre in medulla integrates:

A

neural: from motor centres, joints, muscles, emotions, chemoreceptors
humoral: acids, metabolites and temperatures

67
Q

Ventilatory increase in exercise

A

triphasic
1: neurogenic from both the core and the periphery
2. exponential increase, also neural in origin, some chemoreceptor phasic input
3: fine-tuning, steady state, chemoreceptor drive

68
Q

blood gases in exercise

A

depends on level
light: isocapnic, normoxic
heavy: hypocapnic, hyperopic

69
Q

carriage of o2 in blood during exercise

A

carried by Hb
67x carriage by plasma alone
plateau of reserve
release to tissue made easy
Bohr effect, temperature effect

70
Q

carriage of co2 by blood in exercise

A

7% dissolved in plasma
23% as carb amino compounds
most important is bicarbonate (buffer)

71
Q

blood gases in exercise

A

-increasing exercise, ventilation increases linearly with VO2 until a certain point - ventilatory threshold
-breaks linearity due to lactic acid stimulating the chemoreceptors (ventilatory compensation for metabolic acidosis)
-bicarb falls mole for mole with lactate rise
blood gases then actually fall for CO2 and rise for o2
in this way, sustain lactate load

72
Q

anaerobic threshold

A

-below this level, muscle demands for oxygen are met completely by aerobic means and little lactate is formed
-above, muscles respire anaerobically and produce lactic acid at too great a rate for the body to dispose of
-above: hyperventilation and change in RER, acidosis, unmaintainable exercise level

73
Q

gas transfer

A

-diffusion through alveoli-capillary membrane
-reaction with blood
-matching ventilation to perfusion

74
Q

fick’s law of diffusion

A

rate of diffusion is proportional to (partial pressure gradient x SA x solubility in water) / (membrane thickness x sq root of molecular weight)

75
Q

transfer factor

A

amount of CO transferred per unit time and pressure gradient
amount of gas transferred between the alveoli and the pulmonary capillary blood per unit time and partial pressure gradient

Physiology (4 decks)

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