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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
effects of obstructive disease on lung volumes
Very decreased FEV1 Decreased FVC decreased FEV1/FVC ratio airway resistance increases
26
effects of obstructive disease on lung volumes
decreased FEV1 Decreased FVC same FEV1/FVC ratio decreased compliance
27
Regulation of the pulmonary vasculature and glands by the autonomic nervous system
parasympathetic - muscarinic; contracts smooth muscle, causes mucus gland secretion sympathetic -alpha - constricts blood vessels -beta2 relaxes respiratory smooth muscle
28
what is bronchial asthma
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
29
what is asthma characterised by
episodic, reversible airway obstruction marked airway inflammation
30
types of asthma
extrinsic -> associated with specific allergic reactions intrinsic -> not associated with a known allergen
31
hypersensitivity and IgE and asthma
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
immediate phase components of asthma
Ag -> IgE -> Mast Cell -> release histamine, prostaglandin, leukotrienes, Interleukins -> Increased vascular permeability, mucous production and bronchoconstriction
33
delayed phase components of asthma
incr vascular permeability -> immune cell infiltration -> cytokine release -> inflammation -> reduced airflow, airway hyperreactivity, impaired mucocilliary clearance, edema, airway injury and remodelling
34
2 main classes of drugs used to treat asthma
bronchodilators and anti-inflammatory drugs
35
describe bronchodilators and asthma
reverse bronchoconstriction; reduce AWR; treat wheeze eg B2 adrenoreceptor agonists, mucscarinsic short acting eg salbutamol and long acting salmeterol
36
describe muscarinic receptor antagonists and asthma
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
cysteinyl-leukotriene synthesis inhibitors and receptor antagonists
Zileuton prevent aspirin-sensitive and exercise-induced asthma decrease immediate and delayed responses action is additive with B2-adrenoreceptors agonist
38
anti-inflammatory drugs and asthma
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
pathophysiology of COPD
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
mechanism of COPD
-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
characteristics and long term control of mild COPD
FEV1 greater than 80% predicted short acting bronchodilator when needed
42
characteristics and long term control of moderate COPD
FEV1 50-80% predicted regular treatment with one or more bronchodilators inhaled glucocorticosteroid
43
characteristics and long term control of severe COPD
FEV1 less than 30% of predicted same as moderate and also antibiotics for acute exacerbations by increased secretions; long term oxygen therapy
44
normal PaO2
95mmHg, 12.7kPa
45
normal PaCO2
40mmHg, 5.4kPa
46
normal venous O2
40mmHg, 5.4kPa
47
normal venous CO2
46mmHg, 6.1kPa
48
normal alveolar O2
100mmHg, 13.3kPa
49
normal alveolar CO2
40mmHg, 5.4kPa
50
alveolar minute volume =
=(tidal volume - dead space) x respiratory rate
51
describe haemoglobin
prophrin ring, haem and globin
52
Bohr shift to right
increased PCO2, temp, H+ and 2,3 diphosphoglycerate
53
oxygen-dissociation graph for anaemia
lower and more to right
54
fick principle
oxygen consumption = arteriovenous difference x cardiac output
55
define hypoxia
low PaO2
56
causes of hypoxia
anaemic - low Hb conc stagnant - low blood flow historic - deficiency of tissue utilisation
57
what defends H+ concentration
buffers, respiratory regulation, renal regulation HA <-> H+ + A-
58
what pH is acidosis
<7.35
59
what pH is alkalosis
>7.45
60
what is respiratory acidosis
retention of carbonic acid - increases pCO2 - may be acute or chronic
61
what is non-respiratory (metabolic) acidosis
increased in non-carbonic acids - decreases pCO2 and HCO3-
62
minute volumes at rest vs maximal exercise
rest: 500mls x 12 breaths = 6Lmin-1 exercise: 3500mls x 60 breaths = 200Lmin-1
63
what is dead space
airways that are cartilaginous/parts of respiratory tree not participating in gas exchange
64
alveolar ventilation
amount of air reaching alveoli per minute =(Tv - Td) x RR
65
alveolar ventilation in shallow breathing vs deep breathing
shallow: 150-150 x 40 = 0 deep 1000-150 x 6 = 5100 minute ventilation stays the same
66
respiratory exercise centre in medulla integrates:
neural: from motor centres, joints, muscles, emotions, chemoreceptors humoral: acids, metabolites and temperatures
67
Ventilatory increase in exercise
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
blood gases in exercise
depends on level light: isocapnic, normoxic heavy: hypocapnic, hyperopic
69
carriage of o2 in blood during exercise
carried by Hb 67x carriage by plasma alone plateau of reserve release to tissue made easy Bohr effect, temperature effect
70
carriage of co2 by blood in exercise
7% dissolved in plasma 23% as carb amino compounds most important is bicarbonate (buffer)
71
blood gases in exercise
-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
anaerobic threshold
-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
gas transfer
-diffusion through alveoli-capillary membrane -reaction with blood -matching ventilation to perfusion
74
fick's law of diffusion
rate of diffusion is proportional to (partial pressure gradient x SA x solubility in water) / (membrane thickness x sq root of molecular weight)
75
transfer factor
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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