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BRS (PHYSIO) > RESPIRATORY > Flashcards

RESPIRATORY Flashcards

1
Q

The volume inspired or expired with each normal breath

A

Tidal volume (Vt)

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2
Q

Volume that can be inspired over and above the tidal volume

used during exercise

A

Inspiratory reserve volume (IRV)

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3
Q

The volume that can be expired after the expiration of a tidal volume

A

Expiratory reserve volume

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4
Q

The vlume that remains in the lungs after a maximal expiration

cannot be measured by spirometry

A

Residual volume

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5
Q

2 types of dead space

A

Anatomic

Physiologic

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6
Q

The volue of the conducting pathways

A

Anatomic pathway (approximately 150 mL)

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7
Q

functional measurement

defined as the volume of the lungs that does not participate in gas exhange,

approximately equal to the anatomic dead space in normal lungs.

A

Physiologice dead space

  • may be greater than the anatomic dead space in lung diseases in twhich there are V/Q defects
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8
Q

Physiologic dead space can be calcutated by this equation

A
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9
Q
A
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10
Q

Lung volumes and capacity

A
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11
Q

Minute ventilation is expressed as _______

A

Minute ventilation = Vt x RR

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12
Q

Alveolar Ventilation (VA) is expressed as ________

A

VA = (VT - VD) x RR

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13
Q

The sum of tidal volume and IRV

A

Inspiratory capacity

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14
Q

Sum of ERV and RV

the volume remaining in the lungs after a tidal volume is expired

Includes RV, cannot be measured by spirometry

A

Functional residual capacity (FRC)

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15
Q

Sum of tidal volume, IRV, ERV

the volume of air that can be forcibly expired after a maximal inspiration

A

Vital capacity, or forced vital capacity

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16
Q

Sum of all four lung volumes.

The volume in the lungs after a maximal inspiration

includes RV, so it cannot be measured by spirometry

A

Total lung capacity

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17
Q

the volume of air that can be expired in the first second of a forced maximal expiration

A

Forced expiratory volume (FEV1)

normally 8% if the forced vital capcacity

(FEV1 / FVC) = 0.8

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18
Q

in obstructive disease, such as asthma and COPD, FEV1 and FVC are ______

A

Reduced

  • FEV1 is reduced more than FVC
  • FEV1/FVC = decreased
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19
Q

In restrictive lung disease, such as fibrois, both FEV1 and FVC are _______

A

Reduced

  • FVC is reduced more
  • FEV1/FVC = increased
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20
Q

The most imporatnt muscle of inspiration

A

Diaphragm

  • when the diaphragm contracts, the abdominal contents are pushed downward, and the ribs are lifted upward and outward, increasing the volume of the thoracic cavity
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21
Q

Not used for inspiration during normal quiet brething

used during exercise and in respiratory distress

A

External intercosatal and accessory muscles

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22
Q

Expiration is (active or passive)

A

Passive

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23
Q

Push the diaphragm up and push air out of the lungs

A

Abdominal muscles

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24
Q

Pull the ribs downward and inward

A

Internal intercostal muscles

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25
Q

Analogous to capacitance in the CVS

Distensibility of the lungs and chest walls

A

Compliance

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26
Q

Compliance is ______ related to elastance

A

Inversely

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27
Q

Compliance of the lungs

A
  • Transmural pressure is alveolar pressure minus intrapleural pressure
  • Whenthe pressure outside the lungs is negattive, lung lungs EXPAND and lung volume INCREASES
  • In the middle range of pressures,
    • Compliance is GREATEST and the lungs are most distensible
  • At high expanding pressures
    • Compliance is lowest, the lungs are least distensible and the curve Flattens
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28
Q

Inflation of the lungs follows a different curve than deflation of the lungs (expiration); this difference is called ___________

A

hysteresis

  • due to the need to overcome surface tenson forces when inflating
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29
Q

Compliance of the combined lung-chest wall system

A
  • Compliance of the lung chest wall system is less than of the lungs alone or the chest wall along (slope is flatter)
  • At rest, Lung volume is at FRC and the pressure in the airways and lungs is qual to atmospheric pressure (0)
    • collapsing force of the lungs
    • expanding force of the chest wall
    • interpleural pressure is NEGATIVE
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30
Q

In a patient with emphysema, lung compliance is _____________

A

Increased

  • higher FRc
  • patient’s chest becomes barrel shaped
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31
Q

In a patient with fibrosis, lung compliance is _______

A

Decreased

  • lower FRC
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32
Q

Results from the attractive forces between liquid molecules lining the alveoli at the air liquid interface

A

Surface tension

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33
Q

Cretaes a collapsing pressure that is directly proportional to surface tension and iversely proportional to alveolar radius

A

Laplace’s Law

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34
Q

Large alveoli have ______ collapsing pressures and are easy to open

A

low

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35
Q

Small alveoli have ______ collapsing pressure

A

high

  • In the absence of surfactant, the small alveoli have a tendency to collapse (atelectasis)
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36
Q

Reduces surface tension by disrupting the intermolecular forces between liquid molecules.

Increases co,piance

A

Surfactant

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37
Q

Surfactants are synthesized by

A

Type II alveolar cells

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38
Q

Surfactants are primarily cosnsists of the phospholipid

A

dipalmitoylphosphatidylcholine (DPPC)

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39
Q

In the fetus, surfactant synthesis is variable. Surfactant may be present as early as week ______ and is almost always present by gestation week ______

A

24

35

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40
Q

LEcithin: sphingomyelin ration greater than _____________ in amniotic fluid reflects mature levels of surfatant

A

2:1

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41
Q

driven by and is directly proporional to the pressure difference between the mouth(or nose) and the alveoli

A

Airflow

  • Inversely proportional to airway resistance.
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42
Q

Resistance of the airways is described by ____________

A

Poiseuille’s law

  • Notice the powerful inverse fourth power relationship between resistance and the size (radius) of the airway
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43
Q

Mahor site of airway resistance is the ________-

A

Medium sized bronchi

  • Why not the smallest airways?
    • Parallel arrangemetn
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44
Q

Factors that change airway resistance

A
  • Contraction or relaxation of bronchial smooth muscles
  • Lung volume
  • Viscosity or density of inpired gas
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45
Q

________________stimulation, irritants, and the slow reacting substancce of anaphylaxis (asthma) constrict th airways, decrease the radius and inrease the resistance to airflow

A

Parasympathetic stmulation

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46
Q

_________-__stimualtion dilate the airways via B2 receptors, increases the radius and decrease the resistance to airflow

A

Sympathetic

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47
Q

________associated with greater traction on airways and decreased airway resistance.

A

high lung volumes

  • patients with increased airway resistance learn to breathe at higher lung volumes to offset the high airway resistance associated with their disease
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48
Q

_____________ are associated with less traction and increased airway resitance, even to the point of airway collapse

A

Low lung volumes

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49
Q

During a deep-sea dive, both air density and resistane to airflow are ___________

A

increased

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50
Q

breathing a low density gas, such as helium __________ the resistance to airflow

A

reduces

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51
Q

Breathing cycle`

A
  • At rest
    • Alveolar pressure = atmospheric pressure
    • Interpleural pressure is negative
      • pressure can be measured in the esophagus
    • Lung volume is FRC
  • During inspiration
    • Inspiratory muscles contract and cause the volume of the thorax to increase
      • Lung volume increase, alveolar pressure decrease
      • the pressure gradient causes air to flow
    • Intrapleural pressure becomes more negative
    • Lung volume increase by one Vt
      • peak of inspiration
  • Expiration
    • Alveolar pressure becomes greater than atmospheric pressure
    • Intrapleural pressure returns to its resting value
    • lung volumes returns to FRC
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52
Q

During forced expiration, intrapleural pressure actually becomes _____________

A

Positive

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53
Q

Obstructive disease in which expiration is impaired

Characterized by decreased FVC, decreased FEV1

Air trapping and increased FRC

A

Asthma

  • decreased FEV1/FVC ratio
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54
Q

Combiantion of chronic bronchitis and emphysema

Obstrucive disese with increased lung compliance in which expiration is impaired

Decreased FVC and FEV1

Barrel shaped chest

Increased FRC

A

COPD

  • Decreased FEV1/FVC ratio`
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55
Q

mild hypoxemia

normocapnia

A

Pink puffers

Primarily emphysema

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56
Q

Severe hypoxemia with xyanosis

hypercapnia

A

Blue bloaters

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57
Q

Restrictive disease with decreased lung compliance

decreased in all lung volumes

FEV1/FVC is increased or may be mormal

A

Fibrosis

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58
Q

Dalton’s law of partial pressures

A

as exchange

Partial pressure = Total Pressure x fractional gas concentraion

  • In dry inspired air, partial pressure of O2 can be calculated
    • TP and Fractional O2 is 0.21
    • PO2 = 760 mmHg x 0.21
    • 160 mmHg
  • Humidified tracheal air at 37 degrees, the calculation is odiefied to correct fot the partial pressure of H2O which is 47 mmHg
    • 760 -47 mmHg = 713
    • 713 x 0.21
    • 150 mmHg
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59
Q

Approximately 2% of the systemic cardiac output bypasses the pulmonary circulation

A

Physiologic shunt

  • the admixture of the venous blood and arterial blood makes the PO2 of arterial blood slightly lower han that of alveolar air
60
Q

The amount of gas dissolved in a solution is proportional to its __________

A

Partial pressure

  • The units of concentration of a dissolved gas are mL gas/100 mL blood
61
Q

The diffusion rates of O2 and CO2 depend on the ____________ across the membrane and the area available fo diffusion

A

partial pressure difference

62
Q

Gas diffusion across the alveolar-pulmonary capillary barrier occurs according to __________

A

Fick’s law

  • DL or lung diffusing capacity id the equivaent of permeability of the alveolar-pulmonary capilalry barrier and is proportional to diffusion coefficient of the gas and surface area and inversely proportional to thckness of the barrier
63
Q

DL is measured with ___________

A

carbon monoxide

64
Q

DL ________ during excercise

A

Increases

  • there are more open capillaries and thus more surface area for diffusion
65
Q

DL ________ in emphysema

A

Decreases

  • because of decreased suface area and in fibrosis and pulmonary edema (because of increased diffusion distance)
66
Q

the gas equilibrates early along the length of the pulmonart capillary.

The partial pressure of the gas in arterial blood becomes equal to the partial pressure in alveoalar air

A

Perfusion- limited exchange

  • Illustrated by N2O and O2 under normal conditions
  • diffusion of the as in the arterial blood can be increased only if blood flow increases
67
Q

The gas does not equilibriate by the time blood reacehs the end of the pulmonary capillary

The partial pressure difference of the gas between alveolar air and pulmonary capilalry blood is maintained.

A

Diffusion-limited exhange

  • Diffusion contines as long as the aprtial pressure gradient is maintaine
68
Q

Oxygen is carried in two forms:

A

Dissolved or bound

69
Q

Hemoglobin

A
  • globular protein of four subunits
  • Ferrous state
  • each subunit has a polypetide chain
    • 2 alpha chains
    • 2 beta chains
70
Q

B chains are replace by y-cahins

A

Fetal hemoglobin

71
Q

The oxygen affinity of fetal oxygen is _______________ than adult oxygen

A

Higher

  • becaue of 2,3 diphosphoglycerate (DPG) binds less avidly to the y-chains of fetal hemoglobin
  • Oxygen movement from mother to fetus is facilitated
72
Q

Iron is in the Fe3+ state

Does not bind Oxygen

A

Methemoglobin

73
Q

Causes sickle cell disease

The alpha subunits are normal and the B subunits are abnormal

A

hemoglobin S

  • In the deoxygenated form, deoxyhemoglobin forms a sickle shaped rods that deform red blood cells (RBCs)
74
Q

maximum amount of Oxygen that can be bound to hemoglobin

Limits the amount of oxygen that can be carried in blood

Measured at 100% saturation

A

Oxygen binfing capacity of hemoglobin

  • expressed in units of mL O2/g hemoglobin
75
Q

The total amount of oxygen carried in blood, including bound and dissolved oxygen.

depends on the hemoglobin concentration, the Oxygen binding capacity of hemoglobin, the PO2 and the P50 of Hgb

A

Oxygen content of blood

76
Q

Hemoglobin combines rapidly and reversibly with oxygen to form_______

A

oxyhemoglobin

77
Q

At a PO2 of 100mmHg(arterial blood) _________

A

hemoglobin is 100%saturated; oxygen is bound to all four heme groups on all hemoglobin molecules

78
Q

At PO2 of 40 mmHg _______

A

hemoglobin is 75% saturated, which means that on average, 3/4 heme groups on eah hemoglobin molecule have O2 bound

79
Q

at PO2 of 25 mmHg __________

A

Hemoglobin si 50% saturated

The PO2 at 50% is the P50. 50% saturation means that on average, 2/4 heme groups of each hemoglobin molecule have oxygen bound

80
Q

The __________ shape of the HODC is the result of a chanfe in the affinity of hemoglobin as each successive oxygen molecule binds to a heme site

A

Sigmoid

(Positive coperativity)

  • Binding of the first Oxygen molecule increases the affinity for the second molecule, and so forth
81
Q

The HODC is almost flat when the PO2 is between ______________

A

60-100 mmHg

Humans can tolerate changes in atmospheric pressure (and PO2) without compromising the oxygen carryng capacity of hemoglobin

82
Q

Shifts to the right of HODC

A
  • affinity of hemoglobin is decreased
  • P50 is increased
  • Inrease in PCO2 or decrease in pH
    • BOHR EFFECT
  • Increase in temperature (during exercise)
  • Increase in 2,3 DPG concentration
    • adaptation to chronic hypoxemia
83
Q

Shift to the left of HODC

A
  • affinity of hemoglbin to oxygen is increased
  • P50 is decreased
  • Decreased PCO2
  • Increassed pH
  • decreased temperature
  • decreased 2,3-DPG
  • HbF
  • Carbon monoxide
84
Q

Effect of carbon monoxide poisoning to the HODC

A
  • CO competes for oxygen binding sites on hemoglobin
  • the affnitity for CO is 200x
  • shify to the left
85
Q

Decreased in arterial PO2

caused by deceased PAO2, diffusion defect, V/Q defects, and right to left shunts

86
Q

can be used to compare causes of hypoxemia

A

A-a gradient

87
Q

Normal A-a gradient is ______

88
Q

A-a gradient is _________ if Oxygen does not equlibriate between alveolar gas and arterial blood

A

Increased

  • Diffusion defect
  • V/Q defect
  • Right to left shunt
  • PAO2 is greater the PaO2
89
Q

Decreased oxygen delivery to the tissue

caused by decreased blood flow, hypoxemia, decreased hemoglobin concentration, CO poisoning, and cyanide poisoning

A

hypoxia

  • Oxygen delivery
    • O2 delivery = Cardiac output x Oxygen content of blood
90
Q

oxygen content of blood depends on _________

A
  • Oxygen binding capacity of hemoglobin
  • PO2
91
Q

Cause of hypoxia

92
Q

Is a growth factor that is synthesized in the kidneys in response to hypoxia

Decreased Oxygen delivery to the kidney causes increased production of hypoxia inducible facto 1a

A

Erythropoeitin

93
Q

Produced in the tissues and carried to the lungs in the venous blood

A

Carbon dioxide

  • 3 forms
    • Dissolved
    • Carbaminohemoglobin
    • HCO3 (major form)
94
Q

In the RBCs, carbon dioxide combines with water to form H2CO3, a reaction cataluzed by ___________

A

Carbonic anhydrase.

95
Q

_________leaves the RBCs in exchange for Chloride (chloride shift) and is transported to the lungs in the plasma.

96
Q

H+ is buffered inside the RBCs by ______

A

Deoxyglobin

97
Q

Pressures are much ______ in the pulmonary circulation than in he systemic circulation

98
Q

Resistance is much ________ in the pulmonary circulation than in systemic circulation

99
Q

Cardiac output of the right ventricle is _______

A

Pulmonary blood flow

  • equal to cardiac output of the left ventricle
  • Although pressures int hepulmonary circulation are low, they are sufficient to pump the cardiac output because resistance of the pulmonary circulation is proportionately low
100
Q

When a person is _____ blood flow is nearly uniform throughout the lung

101
Q

When a peron is ____ blood flow is unevenly distributed

A

standing

  • Due to the effect of gravity
    • lowest at the apex (zone 1)
    • highest at the base (zone 3)
102
Q

Zone _____

Blood flow is lowest

Alveolar pressure > arterial pressure > venous pressure

A

1

  • Th higher alveolar pressure may compress the capillaries and reduce the blood flow in zone 1
  • This situation can occure if arterial BP is decreased as a result f hemorrhage or if alveolar pressure is increased because of PPP
103
Q

Zone ______

blow flow is medium

Arterial pressure > alveolar pressure > venous pressure

A

2

  • Moving down the lung, arterial pressure progressively increases because of gravitational effects on arterial pressure
  • Arterial pressure is greater than alveolar pressure in zone 2, and blood flow is driven by the difference between arterial pressure and alveolar pressure
104
Q

Zone_______

Blood flow is highest

Arterial pressure > venous pressure > alveolar pressure

A

3

  • Moving down toward the base of the lung, arterial pressure is highest because of gravitational effects, and venous pressure finally increases to the point where it exceeds alveolar pressure
  • Blood flow is driven by the difference between arterial and venous pressures as in most vascular beds
105
Q

in the lungs, hypoxia causes _________

A

vasoconstriction

106
Q

Right to left shunts

A
  • normally occur to a small extent
  • seen in TOF
  • decrease in arterial PO2
    • admixture of venous blood with arterial blood
107
Q

Left to right shunts

A
  • more common that right to left shunts
    • pressure are higher on the left side of the heart
  • congenital abdonormalities (PDA) or taumatic injuries
  • Do not result in decrease in arterial PO2.
  • PO2 will be elevated on the right side of the hear because there has been admixture of arterial blood with venous blood
108
Q

Ration of alveolar ventilataion to pulmonary blood flow

A

V/Q ratio

  • if the RR, tidal volume, cardiac output are normal, the V/Q is approximatly 0.8
    • this V/Q results in an arterial PO2 of 100 mmHg and an arterial PCO2 of 40 mmHg
109
Q

Blood flow or perfusion is ____a_____at the apex and _____b_____in the base

A

A: Lowest

B: Highest

  • because of gravitational effects on arterial pressure
110
Q

Ventilation is _______at the apex and _______at the base

A

A : lower

B: higher

  • Gravitaional effect in the upright lung
  • regional differences for ventialtion are not as great as for perfusion
111
Q

V/Q ration is higher at the __________

112
Q

If the airways are completely bloockedm the ventilation is zero. If bblood flow is normal then _____

A

V/Q is zero

Called a shunt

  • no gas exchange in a lung that is perfused but not ventialted
  • the PO2 and PCO2 of pulmonary capilalry blood will approach their values in mixed venous blood
  • increased A-a gradient
113
Q

If blood flow is completely bcoked, then the blood flow to that lung is zero. If ventilation is normal then _____

A

V/Q is infinite

Dead space

  • No gas excahnge
  • PO2 and PCO2 of alveolar gas wil aproach their values in inspired air
114
Q

Sensory information (PCO2, lung stretchm irritants, muscle spindles, tendons, and joints) is coordination in the _______

A

Brain stem

115
Q

Medullary respiratory center is located in the ____________

A

reticular formation

116
Q

primarily for inspiration and generates the basic rhythm for breathing.

A

Dorsal respiratory group

117
Q

Input to the dorsal respiratory group comes from the ____ and _____ nerves

A

Vagus and Glossopharyngeal

  • Vagus = from peripheral chemoreceptors and mechanoreceptors
  • Glossopharyngeal nerve = from peripheral chemoreceptors
118
Q

Output from the dorsal respiratory group travels via ______________

A

Phrenic nerve

119
Q

Priamarily responsible for expiration

not active during normal, quiet breathing, when expiration is passive

A

Ventral respiratory group

120
Q

Apneustic center is located in the _______

A

lower pons

121
Q

Stimulates inspiration, producing deep and prolonged inspiratory gasp

A

apneustic center

122
Q

Pneumotaxic center is located in the _______

A

upper pons

123
Q

Inhibits inspiration and, therefore regulates inspiratory volume and respiratory rate

A

Pneumotaxic center

124
Q

Central chemoreceptors in the medulla are sensitive to the _____ of the CSF.

125
Q

Decrease in the pH of the CSF produce ________ in breathing rate

A

increase (hyperventilation)

126
Q

The _______ are located at the bifurcation of the common carotid arteries

A

Carotid bodies

127
Q

The ______ are located above the aortic arch

A

Aortic bodies

128
Q

Decrease ina rterial PO2 stimulate the peripheral chemoreceptors and __________ breathing rate

129
Q

PO2 must decrease to ________ before breathing is stimulated.

130
Q

__________ in arterial PCO2 stimulate peripheral chemoreceptors to increase breathing rate

A

Increase

  • Potentiate the stimulation of breathing caused by hypoxemia
131
Q

The respnse o the peripheral chemoreceptors is _______ important than is the responsse of the central chemoreceptors to CO2 or H+

132
Q

In _____________.(Metabolic/respiratory ; acidosis/alkalosis) breathing rate is increased

A

Metabolic acidosis

133
Q

located in the smooth muscle airways

when these receptor ae stimulatedm they produce a decrease in breathing frequency

A

Lung stretch receptors

(HERING-BREUER REFLEX)

134
Q

Located between the airway epithelial cells

stimulated by noxious substances

A

Irritant receptors

135
Q

Located in the alveolar walls, close to the capillaries.

Engorgement of the pulmoanry capillaries, such as that may occur with left heart failure stimulates this receptors, which then cause rapid, shallow breathing

A

J receptors

136
Q

activated during movement of limbs

Involved in the early stimulation of breathing during exercise

A

joint and muscle receptors

137
Q

Summary of respiratory response to exercise

138
Q

Summary of adaptation during High altitudes

139
Q

The mean values for PO2 and PCO2 _____________during exercise

A

Do not

  • arterial pH does not change during moderate exercise, although it may decrease during strenuous excercise because of lactic acidosis
140
Q

Venous PCO2 ______ during exercise beause the excess CO2 produced by exercising muscle is carried to the lungs in venous blood

141
Q

Pulmonary blood flow ________ during exercise

A

Increases

  • because cardiac out increases duringe xercise. As a result, more pulmonary capillaries are perfused, and more gas exchanged occurs.
    • Decrease in the physiologic dead space
142
Q

Alveolar PO2 is ____ at high altitude

A

Decreased

  • barometric pressure is decreased.
143
Q

Hyperventilation produces respiratory alkalosis, which can be treated by administering ________

A

Acetazolamide

144
Q

2,3 DPG conentrations are _______ in high altitudes

145
Q

______________is a result of hypoxia. there is increase in pulmonary arterial pressure, increased work of the right sisde of the heart against the higher resistance, and hypertrophy of theright ventricle

A

Pulmonary vasoconstriction

BRS (PHYSIO) (14 decks)

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