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PathoPhysiology Respiratory - CP > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Which volume remains in the lungs after a maximal expiration?

A

Residual volume (volume you can’t move out unless detached)

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2
Q

Which of the following is not a muscle of inspiration?

a. diaphragm
b. external intercostals
c. sternocleidomastoid muscles
d. internal intercostals
e. anterior scaleni

A

D. Internal intercostals (muscle of expiration)

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3
Q

Do the abdominal and internal intercostal muscles actively contract during normal tidal breathing?

A

No, it is passive (unless have ailment)

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4
Q

During exercise, one needs to exchange more gas into and out of the lungs. Why?

A

Increasing metabolic rate so need more oxygen because you need to burn more fuel

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5
Q

What happens to IRV during exercise? What muscles are involved in this adaptation?

A

Decreases, accessory muscles of inspiration (sternocleidomastoid, anter. serrati, scalene)

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6
Q

What happens to ERV during exercise? What muscles are involved in this adaptation?

A

Decreases, accessory muscles of expiration (internal intercostals, abdominal)

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7
Q

FRC is always the amount of gas remaining in the lungs when chest wall elastic recoil and lung elastic recoil are ___

A

equal and opposite! (if not the lung and chest would be moving, the FRC is where the lung and chest wall come to rest)

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8
Q

vital capacity

A

4500-5000mL, max amount of gas we can move

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9
Q

total lung capacity

A

5700-6200 mL, includes RV + VC

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10
Q

do we have more inspiratory reserve or expiratory reserve?

A

inspiratory reserve, more energy efficient thing to do is increase inspiration because our inspiratory muscles are. used all the time so it is easy to recruit more of them

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11
Q

expiratory reserve volume

A

1000-1200mL, extra volume with recruitment of accessory muscles

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12
Q

inspiratory reserve volume

A

3000-3300mL, recruit more volume with accessory muscles to increase gas exchange

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13
Q

As the respiratory system volume gets smaller, lung elastic recoil pressure ___ and chest wall outward elastic recoil pressure ___

A

decreases, increases (to a certain point)

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14
Q

as the respiratory system volume enlarges, the lung elastic recoil pressure __ and the chest wall outward recoil pressure ___

A

increases, decreases

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15
Q

the total respiratory system elastic recoil pressure is the sum of

A

lung elastic recoil pressure + chest wall elastic recoil pressure

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16
Q

at lung volume of 4.5L the chest wall is at its equilibrium position so the chest wall elastic recoil pressure is ___

A

neither inward or outward

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17
Q

at lung volume of 4.5L the chest wall is at its equilibrium position therefore the total respiratory system elastic recoil pressure depends on ____

A

lung elastic recoil pressure (inward)

ALWAYS INWARD UNLESS PNEUMO

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18
Q

at respiratory volume >4.5L the chest wall elastic recoil pressure becomes ___

A

an inward recoil pressure

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19
Q

at what volume is chest wall outward recoil pressure maximal?

A

1200- residual volume (when maximally compressed)

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20
Q

at TLC the direction of lung elastic recoil pressure is maximally ___ and the direction of the chest wall elastic recoil pressure is _____

A

inward, inward

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21
Q

what is the equilibrium position of the detached lung?

A

collapsed

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22
Q

at what point during a normal tidal breath does the lung reach its equilibrium position?

A

it doesn’t unless you have a pneumo.

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23
Q

during normal tidal breathing the pressure gradient responsible for moving air into and out of the lungs is represented by the difference between ___

A

atmospheric and alveolar pressures (Pbarometric - Palveolar = delta P)

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24
Q

How can a healthy person generate an increased rate of expiratory gas flow from the lungs?

A

exercising- reduce reserve by utilizing more, increase expiratory gas flow, more oxygen demand more gas exchange by taking larger volume, increase elastic recoil, recruit accessory muscles

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25
Q

Does lung fibrosis change the intrinsic elastic recoil of the lung?

A

Yes, (think thick rubber band- extra collagen- increase lung elastic recoil)

26
Q

Does lung fibrosis change the intrinsic elastic recoil of the chest wall?

A

No

27
Q

How does lung fibrosis impact FRC?

A

increase Pel inward and chest wall outward (same)

so increase in Pel = smaller volume = decreased FRC

28
Q

At FRC someone with lung fibrosis will have what sized alveoli compared to a healthy person?

A

Smaller (decreased compliance, smaller volume in alveoli, can’t stretch d/t fibrotic tissue)

29
Q

Does being supine affect FRC?

A

Yes! increase WOB, decrease chest wall recoil outward pressure, gravity won’t allow it to fully expand, so decrease FRC

30
Q

Does the elastic recoil pressure in your lung change as you move from FRC to TLC?

A

Yes, the length changed (extrinsic), increase in volume, more stretch, increase Pel, at TLC Pel and chest wall both inward

31
Q

How does the chest wall move with inspiration?

A

upward and outward

32
Q

How does the sternum move during inspiration with someone who has a complete transection at C7?

A

move inward d/t negative intrapleural pressure because diaphragm is still moving so it is pulling everything down

33
Q

Would the volume of gas that remains in the lungs at end expiration (FRC) be changed by a C7 transection

A

wouldn’t be able to push as much air out, FRC would be less, less pulling outward

34
Q

Why would someone who aspirated recruit their accessory muscles to breathe after expelling the water?

A

lost surfactant (alveoli collapsed) so increase in ALI, increase Pel, increase WOB, need to drive more pressure in to overcome adhesive forces

35
Q

In terms of positioning when is FRC maximal? lowest?

A

Maximal- standing upright, lowest- lying with head tilted down

36
Q

How does body position affect FRC?

A

affected by extrinsic factors, the length of the fibers, when standing upright gravity pulls lungs down, when laying down with your head tilted back- guts push up reducing the outward chest recoil, decrease compliane, diameter volume and FRC, increase resistance and wob

37
Q

Does closing volume change with body position?

A

No, depends on intrinsic factors

38
Q

If an emphysema patient has a closing volume of 3 L and an FRC of 3.5 L what lung mechanical difficulties would they have when they lie down?

A

increased closing volume, decreased lung elastic recoil, FRC lowers

39
Q

What advantage could dynamic compression serve?

A

cough- more effective when gas molecules are closer to airway wall to help move mucous up the airway

40
Q

During passive expiration the driving pressure for gas out is

A

Pa-Pb

41
Q

During forced expiration the driving pressure for gas out is

A

Pa - Ppl

42
Q

Compare dynamic compression of the airways of emphysema patients to healthy patients

A

Emphysema- earlier airway closure, increase gas trapping, greater dynamic compression

43
Q

Why do systolic and diastolic pressures change vertically across the lung?

A

gravity

44
Q

How does pulmonary capillary pressure and alveolar pressure influence the flow of blood through pulmonary capillaries?

A

Ppc < Palv. otherwise would constrict

45
Q

Regional distribution of Blood Flow - Zone 1

A

Doesn’t usually exist in healthy individuals, no blood flow, apex level, systolic 10/ dialstolic 0

46
Q

Regional distribution of Blood Flow - Zone 2

A

Intermittent blood flow, heart level, systolic 25/diastolic 8

47
Q

Regional distribution of Blood Flow - Zone 3

A

Continuous blood flow, base level, systolic 33/diastolic 16

48
Q

How does being supine affect pulmonary distribution of blood flow?

A

gravity less effect, more blood flow, small distance between anterior and posterior, the posterior will be the dependent region

49
Q

How does PEEP effect zone 1?

A

increase in Pa, increase tendency to get zone 1, more pressure on capillary so less blood flow (change in alveolar pressure)

50
Q

How does hemorrhage effect zone 1?

A

decrease in pulmonary systolic, pulmonary capillary pressure, and mean pressure, pulmonary pressure < Pa (change in pulmonary pressure)

51
Q

How does exercise effect zone 1?

A

increases blood flow, diastolic would increase, would be continuous rather than intermittent

52
Q

Nondependent region of lung

A

upper lobe, above heart

ventilation: intrapleural pressure more negative, greater transmural pressure gradient, alveoli larger, less compliant, less ventilation
perfusion: lower intravascular pressures, less recruitment, higher resistance, less blood flow

53
Q

Dependent region of lung

A

lower lobes

ventilation: intrapleural pressure less negative, smaller transmural pressure gradient, alveoli small, more compliant, more ventilation
perfusion: greater vascular pressure, more recruitment, lower resistance, greater blood flow

54
Q

Why are alveoli in the bases smaller?

A

gravity, pulls tissues down and compresses

55
Q

What effect does gravity have on lung inside the chest cavity?

A

pulls the alveoli in nondependent region down making them larger and compress the alveoli in the dependent region making them smaller

56
Q

Dependent region of lung

A

smaller alveoli, more compliant

57
Q

Nondependent region of lung

A

larger alveoli, less compliant

58
Q

When a forced expiration takes lung volume down to closing volume which lung region will be more likely to collapse?

A

Dependent close first- less elastic lung recoil, smaller, less radial traction, increase surface tension in airway

59
Q

When at RV which lung region will inflate first during the next inspiration?

A

nondependent will open first until can pop open the lower

60
Q

What lung pathologies would lead to increased airways resistance?

A

asthma, emphysema - increased radial traction, loss of elastic recoil, easier for them to inhale than to exhale

61
Q

Transmural pressure

A

across the wall of the airway

62
Q

Transpulmonary pressure

A

across the alveoli

PathoPhysiology Respiratory - CP (4 decks)

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