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respiratory Flashcards

1
Q

What structures contribute to the respiratory pump?

A

Bones (ribs and sternum), muscles (diaphragm and intercostals), pleura, nerves.

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2
Q

What structures make up the conducting airways?

A

Nose, pharynx, larynx, trachea, bronchi, bronchioles, terminal bronchioles.

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3
Q

What is the function of the conducting airways?

A

To filter, warm, humidify and conduct air to the lungs.

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4
Q

What is respiratory epithelium?

A

Pseudo-stratified, columnar, ciliated, interspersed with goblet cells.

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5
Q

Where is the resistance greatest in the airway?

A

In the trachea - the trachea is longer (length adds resistance) and there is only one of it (branching decreases resistance).

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6
Q

What equation can be used to demonstrate resistance of an airway?

A

Poiseuille’s law: R = 8ƞl / πr^4.

ƞ = viscosity, l = length

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7
Q

Briefly describe inspiration.

A

Inspiration is an active process. The external intercostal muscles and diaphragm contract. The volume of the thoracic cavity increases and you get a negative intra-thoracic pressure; air is drawn in.

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8
Q

Briefly describe expiration.

A

Expiration is usually passive. The ribs move down and in, the diaphragm relaxes. The intra-thoracic volume decreases and the pressure increases. Air is forced out.

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9
Q

Which muscles are involved in active expiration?

A

The internal intercostals; these muscles contract pulling the ribcage inwards and downwards.

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10
Q

What is V/Q mismatch?

A

When the perfusion of blood in capillaries isn’t matching the ventilation of the alveoli.

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11
Q

What is it called when you have a high V/Q ratio?

A

Dead space. Lots of ventilation but no perfusion.

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12
Q

What is a cause of a high V/Q ratio (dead space)?

A

Pulmonary embolism.

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13
Q

What is it called when you have a low V/Q ratio?

A

Shunt. Lots of perfusion but no ventilation.

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14
Q

What is a cause of a low V/Q ratio (shunt)?

A

Pulmonary oedema.

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15
Q

What is perfusion of pulmonary capillaries dependent on?

A
  1. Pulmonary artery pressure.
  2. Pulmonary venous pressure.
  3. Alveolar pressure.
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16
Q

Does the apex of the lung have a high or a low V/Q? Why?

A

High - effect of gravity, far more perfusion at the base of the lung.

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17
Q

What are the 7 layers for gas exchange?

A
  1. Alveolar epithelium.
  2. Interstitial fluid.
  3. Capillary endothelium.
  4. Plasma layer.
  5. RBC membrane.
  6. RBC cytoplasm.
  7. Hb binding sites.
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18
Q

Name 4 causes of hypoxia.

A
  1. Hypoventilation.
  2. V/Q mismatch.
  3. Diffusion abnormality.
  4. Reduced PiO2.
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19
Q

Name 4 causes of hypercapnia.

A
  1. Increased dead space ventilation; rapid, shallow breathing.
  2. V/Q mismatch.
  3. Increased CO2 production.
  4. Reduced minute ventilation.
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20
Q

What is the alveolar gas equation?

A

PAO2 = PiO2 - (PaCO2/R)

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21
Q

What is Dalton’s law?

A

In a mixture of non reacting gases Ptotal = Pa + Pb. (P total is the sum of the pressures of individual gases).

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22
Q

What is Boyle’s law?

A

Pressure and Volume are inversely proportional:

P1V1 = P2V2.

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23
Q

What is Henry’s law?

A

The solubility of a gas is proportional to the partial pressure of the gas. S1/P1 = S2/P2.

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24
Q

What is Laplace’s law?

A

P = 2T/R.

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25
What is the significance of Laplace's law?
It tells us that small alveoli have a greater pressure and so air will move from small alveoli to larger alveoli; uneven aeration. (Surfactant can prevent this).
26
Where is surfactant produced?
It is produced by type 2 pneumocytes in the alveoli.
27
When is surfactant produced?
It starts being produced from 34 weeks gestation and production increases rapidly 2 weeks before birth.
28
List 4 functions of surfactant.
1. Prevents alveoli collapse. 2. Allows homogenous aeration. 3. Reduces surface tension. 4. Maintains functional residual capacity.
29
Briefly describe the controller-effector-sensor loop.
The sensor detects a change (hypoxia), sends signals along the afferent pathway to the controller. The controller then sends signals along the efferent pathway to the effector. The effector responds.
30
What does the pneumotaxic area do and where is it located?
It switches off inspiratory neurones and so allows expiration. It is located in the upper pons.
31
What does the apneustic centre do and where is it located?
It inhibits expiration by activation of inspiratory neurones. It is located in the lower pons.
32
What is the acid/base dissociation equation?
CO2 + H2O = H2CO3 = HCO3- + H+
33
Where are RASR (rapidly adapting stretch receptors) located?
Between airway epithelial cells.
34
How do RASR respond to activation?
Bronchoconstriction.
35
What activates RASR?
Lung distension and irritants.
36
Where are central chemoreceptors located?
Medulla oblangata.
37
What stimulates central chemoreceptors?
An increase in H+ concentration in the ECF.
38
Where are peripheral chemoreceptors located?
Carotid and aortic bodies.
39
What stimulates peripheral chemoreceptors?
A decrease in PaCO2.
40
What is the respiratory drive more senstitive to, CO2 or O2?
It is very sensitive to CO2 and so CO2 is a greater drive. A small change in PaCO2 results in a large ventilatory change.
41
Oxygen dissociation curve: what causes the curve to shift to the right?
An increase in temperature and a decrease in pH.
42
Oxygen dissociation curve: what does it mean when the curve shifts to the right?
There is increased O2 unloading. Hb's affinity for oxygen has decreased.
43
Oxygen dissociation curve: what causes the curve to shift to the left?
A decrease in temperature and an increase in pH.
44
What is a cause of respiratory acidosis?
Inadequate ventilation; could be due to obstruction e.g. COPD.
45
What is the renal compensation mechanism for respiratory acidosis?
Increased ammonia formation. H+ secretion increases and there is increased HCO3- reabsorption.
46
What can cause respiratory alkalosis?
Hyperventilation in response to hypoxia.
47
What is the renal compensation mechanism for respiratory alkalosis?
H+ secretion decreases; more H+ is retained. HCO3- secretion.
48
What is a cause of metabolic acidosis?
Renal failure; loss of HCO3-, excess H+ production.
49
What is the respiratory compensation mechanism for metabolic acidosis?
Chemoreceptors stimulated, enhancing respiration, PaCO2 decreases.
50
What is the respiratory compensation mechanism for metabolic alkalosis?
Chemoreceptors are inhibited, reduced respiration, PaCO2 increases.
51
What is a cause of metabolic alkalosis?
Vomiting; loss of H+.
52
Is respiratory compensation fast or slow?
Fast
53
What is type 1 respiratory failure and what are its causes?
Hypoxemia. | Causes: V/Q mismatch due to alveolar hypoventilation, high altitude, shunt, diffusion problem.
54
What is type 2 respiratory failure and what are its causes?
Hypoxemia and hypercapnia. | Causes: inadequate alveolar ventilation due to reduced breathing effort, decreased SA, neuromuscular problems
55
What is forced vital capacity?
Volume of air that can be forcibly exhaled after maximum inhalation.
56
How can you work out total lung capacity?
Add vital capacity to residual volume.
57
What is tidal volume?
The volume of air moved into or out of the lungs during normal, quiet breathing.
58
What changes are seen in an aging lung?
Decreased compliance, muscle strength, elastic recoil, immune function. Decreased response to hypoxia and hypercapnia. Impaired gaseous exchange.
59
What happens to the FEV1 and FVC in an elderly person?
They both decrease and the residual volume increases.
60
What is the parasympathetic neurotransmitter in the lungs?
Acetylcholine.
61
What is the sympathetic neurotransmitter in the lungs?
Noradrenaline.
62
What is the effect of Ach on the pulmonary vessels?
Bronchoconstriction and vasodilation.
63
What is the effect of noradrenaline on the pulmonary vessels?
Bronchodilation and vasoconstriction.
64
Name 2 receptors for Ach.
Muscarinic (G protein coupled) and Nicotinic (ligand gated ion channels).
65
Host defense: What is innate immunity?
Immunity that doesn't require prior exposure. It usually involves phagocytosis and inflammation.
66
What is the function of the epithelial barrier in host defense?
Moistens and protects airways. | Functions as a barrier to pathogens and foreign matter.
67
Define anatomical dead space.
The volume of air taken in during a breath that does not enter the alveoli
68
Define physiological dead space.
The volume of air that is taken in during a breath that does not take part in gas exchange.
69
What it total lung capacity equal to?
TLC = VC + RV.
70
Where is the basic neural machinery for the generation of the respiratory rhythm located?
In the lower medulla.
71
Which alveoli are preferentially ventilated and perfused?
Those at the base of the lungs.
72
Why can hypoxia cause respiratory alkalosis?
Hypoxia leads to hyperventilation as the person tries to inhale more O2. This means you lose a lot of CO2 resulting in alkalosis.
73
Define total lung capacity.
The vital capacity plus the residual volume. It is the maximum amount the lungs can hold.
74
Define residual volume (RV).
The volume of air remaining in the lungs after a maximal exhalation.
75
Define functional residual capacity (FRC).
The volume of air remaining in the lungs after a tidal volume exhalation.
76
Define tidal volume (TV).
The volume of air moved in and out of the lungs during a normal breath.
77
Define FEV1.
The volume of air that can be forcibly exhaled in 1 second.
78
What 2 equations can be used to work out TLC?
1. TLC = VC + RV. | 2. TLC = TV + FRC + IRV.
79
Define forced vital capacity (FVC).
The maximum volume of air that can be forcibly exhaled after maximal inhalation. Usually in 6 seconds.
80
What is lung compliance?
A measure of the lung's ability to stretch and expand. Compliance = ∆V/∆P.
81
Why do you see decreased elastic recoil in an ageing lung?
The elastin degenerates and ruptures.
82
What can the pneumotaxic area override?
The apneustic area.
83
Give 2 ways that oxygen is carried around the body?
1. Bound to Hb. | 2. Dissolved in blood.
84
What is Hb affinity for O2?
How readily Hb acquires and releases O2 at respiring tissues.
85
Define vital capacity.
The maximum volume of air that can be exhaled after a maximal inhalation.
86
What cell type lines most of the surface of an alveoli?
Type 1 pneumocytes. | Type 2 are more numerous but type 1 are squamous and so are responsible for more of the SA.
87
Define airway obstruction.
Impediment to inspiratory and expiratory air flow.
88
Define airway restriction.
When the lungs are restricted from full expansion.

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