Respiratory Physio Flashcards
1
Q
Lung Marker
A
Functional Residual Capacity
2
Q
No gas exchange
A
Conducting zone
3
Q
Nose to terminal bronchioles
A
Conducting zone
4
Q
With gas exchange
A
Respiratory zone
5
Q
Respiratory bronchioles, alveolar ducts, alveolar sacs
A
Respiratory zone
6
Q
How many generation of airways do you find in the respiratory system?
A
23
7
Q
How many alveoli are present in the respiratory system?
A
500 million
8
Q
500 ml
A
Tidal Volume
9
Q
An atomic dead space
A
150 ml
10
Q
Physiologic dead space
A
350 ml
11
Q
Maintain oxygenation even in between breaths
A
Residual volume
12
Q
Maximum amount exhale/inhale
A
VC / vital capacity
13
Q
Alveolar pressure = atmospheric pressure (equilibrium
A
FRC
14
Q
Left sided heart failure
A
Alveolar Macrophage
15
Q
Associated with hemolysis
A
Bronchial blood vessels
16
Q
What is the sympathetic effect on the smooth muscles of the airways?
A
Relaxation (Beta 2)
17
Q
What is the parasympathetic effect on the smooth muscles of the airways?
A
Contraction (Muscarinic receptors)
18
Q
For gas exchanges with 96 - 98% surface area
A
Type 1 pneumocyte
19
Q
Small, cuboidal, found at the corners of alveoli, for surfactant production with 2-4% surface area
A
Type 2 pneumocyte
20
Q
Keep alveoli free of dust and debris
A
Alveolar macrophages
21
Q
In CHF: may convert to siderophages/ Hemosiderin-laden macrophages
A
Alveolar macrophages
22
Q
Produce mucus
A
Goblet cells, submucosal glands
23
Q
In COPD: hyperplasia, hypertrophic seen
A
Goblet cells, submucosal glands
24
Q
May play a role in epithelial regeneration after injury by secreting protective GAGs
A
Clara Cells/ Club Cells
25
Carries DEOXYGENATED Blood to the lungs (respiratory bronchioles, alveolar ducts, alveoli)
Pulmonary Circulation
26
"Sheet" arrangement
Pulmonary Capillaries
27
Carries OXYGENATED BLOOD to the lungs (conducting airways & surrounding tissues)
Bronchial Circulation
28
Pulmonary veins returns to Left atrium alone
Pulmonary circulation
29
Capable of Angiogenesis
Bronchial circulation
30
1/3 returns to right atrium via bronchial veins
| 2/3 returns to the left atrium via pulmonary veins
Bronchial circulation
31
4 basic lung volumes
IRV
TV
ERV
RV
32
4 lung capacities
IC
FRCVC
TLC
33
Cannot be measured directly by spirometers
FRC
IRV
RV
TLC
34
Amount of air inspired/expired during quiet breathing
TV
35
Maintains oxygenation in between breaths
RV
36
Equilibrium/Resting volume of the lungs
FRC
37
Marker of Lung function
FRC
38
Differences among sexes
Lung volumes and capacities 20-25% lower in females
39
Factors that increase VC
Body size, male gender, conditioning, youth
40
Asthma, COPD,
Obstructive
41
Interstitial lung disease
Restrictive
42
Which of the following lung volumes or capacities can be measured by spirometers
Vital Capacity
43
Refers to the amount of air left in the lungs after a regular normal exhalation?
Functional residual capacity
44
Anatomic dead space + alveolar dead space
Physiologic dead space
45
Air in the conducting zone
Anatomic dead space (150 ml)
46
Air in the alveoli not participating in gas exchange due to V/Q mismatch
Alveolar Dead Space (9 mL)
47
Total rate of air movement in/out of the lungs
Minute Ventilation
48
Minute ventilation corrected for physiologic dead space
Alveolar Ventilation
49
What happens to the FEV1 and FVC in patients with obstructive and restrictive lung diseases?
Decreases
50
What is the FEV1/FVC ratio of a healthy person?
80%/ .8
51
What happens to the FEV1/FVC ratio in patients with obstructive and restrictive lung disease respectively
Obstructive: decreased
Restrictive: normal to increased
52
A 60 year old male patient came to the clinic complaining of exertion all dyspnea, he presents with some muscle wasting, increase anteroposterior diameter of the chest, O2 seats were 92% on ambient air auscultation revealed occasional wheezing on both lung basest (-) crackles, (-)bipedal edema, (-) Orthoptera, PND, patient is a known 40 pack year smoker. X-ray revealed hyper aerated lung fields, low set diaphragm. What is the expected finding in spirometers?
Decreased FEV1
53
All of the following are true statements pertaining to the patient above except?
A. There is decreased are for gas diffusion due to alveolar destruction
b. There is increased lung compliance
C. There is decreased lung recoil
D. There is decreased airway resistance due to loss of tethering effect
D. There is decreased airway resistance due to loss of tethering effect
54
His ABG reaves ad pH=7.35 PCO2 = 5- HCO3 28 PO2 90, which of the following is correct?
A. Has acute respiratory acidosis
B. Has acute respiratory alkalosis
C. There is a shift of the hemoglobin dissociation curve to the left
D. There is decreased affinity of hemoglobin to oxygen
D. There is decreased affinity of hemoglobin to oxygen
Do: respiratory acidosis with renal compensation
55
After a month, the patient had a severe exacerbation leading to acute respiratory failure which necessitated mechanical ventilators, patients condition was stabilized with latest ABG after 12 hours showed pH 7.47 PCO2 30 HCO3 24 PO2 95 Fi)2 40% VT 500 mL AC mode RR 16 PEEP 5. What is the next best step?
Decrease the RR to 12
56
Forced Inspiration
External intercostals, SCM, anterior serrati, scalene, Alae Nasir, genioglossus, arytenoid
57
Inspiration
Ribs upward and outward; abdominal contents downward
58
Forced Expiration
Internal intercostals, reclusive abdominal, internal and external oblique, transversus abdominis
59
Expiration
Ribs downward and inward, abdominal contents upward
60
```
Pathology: loss of elastic fiber
Compliance: increased
Elasticity: decreased
FRC: increased
Effects: barrel shaped chest
```
Emphysema
61
```
Pathology: stiffening of lung tissue
Compliance: decreased
Elasticity: increased
FRC: decreased
Effects:
```
Fibrosis
62
Force caused by water molecules at the air-liquid interface that tends to minimize surface area
SurfaceTension
63
Cell that produces surfactant
Type 2 pneumocyte
64
Main component of surfactant
Water
65
Active component of surfactant
Dipalmitoyl-phosphatidylcholine (DPPC) / Lecithin
66
Mechanism for DPPC reducing surface tension
Amphipathic nature (Hydrophobic and hydrophilic)
67
Effect of surfactant on lung compliance
Increase
68
Start of surfactant production
24th week AOG
69
Maturation of surfactant
35th week AOG
70
Test for surfactant
Amniotic L:S Ratio
71
Treatment for newborn RDS
Steroids, Surfactant
72
Airway resistance
Poiseuille's law
73
Major site of airway resistance
Medium-sized bronchi
74
Factors affecting Airway Resistance
Bronchial smooth muscle
Lung volume
Viscosity/density of inspired gas
75
Ability of the respiratory membrane to exchange gas between the alveoli and the pulmonary blood
Diffusing Capacity
76
Diffusing capacity for O2
At rest: 21 ml/min/mmHg
| Maximal Exercise: 65 ml/min/mmHg
77
Diffusing capacity for CO2
At rest: 400 - 450 ml/min/mmHg
| Maximal Exercise: 1200 - 1300 ml/min/mmHg
78
What are the forms of gases in solution?
Dissolved gas, bound gas, chemically modified gas
79
What is the only form of gas that contributes to partial pressure
Dissolved gas
80
What is the only gas in inspired air found exclussively as dissolved gas?
Nitrogen
81
Decrease in arterial PO2
Hypodermic
82
Used to compare causes of hypo emit
A-a gradient
83
Normal A-a gradient
< 10 mmHg
84
Decreased O2 deliver to the tissues
Hypoxia
85
Which of the following causes of hypoxia is characterized by a decreased arterial PO2 and an increased A-a gradient?
Right to left cardiac shunt
86
All of the following conditions causes both a decrease in PaO2 and increase in A-a gradient except?
A. Pulmonary fibrosis
B. V/Q of 0 or low V/Q state like airway obstruction
C. Right to left cardiac shunt
D. High altitude sickness
High altitude sickness
87
Gas equilibrates with the pulmonary capillary near the start of the pulmonary capillary
Diffusion of gas increased only by increasing blood flow
Perfusion-Limited Gas exchange
88
Gas does not equilibrates even until the end of the pulmonary capillary
CO and O2 during strenuous exercise and disease states (emphysema, fibrosis)
Diffusion-Limited Gas Exchange
89
O2 transport rest
Perfusion-Limited
90
O2 transport during exercise and diseased state
Diffusion-Limited
91
O2 transport in high altitude
Slow
92
Equilibration of O2 at sea-level
1/3 length of Pulmonary Capillary
93
Equilibration of O2 at high altitude
2/3 length of Pulmonary Capillary
94
Percentage of Dissolved O2
2%
95
Percentage of O2 bound to HgB
98%
96
HgB with attached O2
Oxyhemoglobin
97
HgB without attached O2
Deoxyhemoglobin
98
HgB with Fe3+; doesn't bind O2
Methemoglobin
99
a2y2, higher affinity for O2
Fetal hemoglobin (HbF)
100
aA2Bs2 sickles RBCs, less affinity for O2
Hemoglobin S
101
Max O2 binding with HgB
O2-binding capacity
102
% of blood that gives up its O2 as it passes through the tissues
Utilization Coefficient
103
Binding of first O2 molecule increases affinity for second O2 molecule and so forth
Exhibits Positive Cooperativity
104
Increased UNLOADING of O2 to HgB
Increased P50
Due to increased Carbon Dioxide, Acidosis, 2,3 BPG, Exercise, Temperature
Shift to the Right
105
Increased BINDING of O2 to HgB
Decreased P50
Due to Increased Carbon Monoxide, HbF
Shift to the Left
106
Cherry red appearance
CO poisoning
107
A patient was found one winter evening by her relatives at home in a comatose state right beside the gas heater, labs revealed normal PaO2 and O2 saturation of 97%, what is the most likely condition?
CO poisoning
108
The condition in the patient above causes which of the following physiologic effects?
Left shift of the oxyhemoglobin dissociation curve
109
In relation to the patient above, which of the following is true if P50 of HgB was found to have gone down to 20 mmHg?
Affinity of hemoglobin to O2 increases
110
90% of CO2 in the blood
HCO3
111
5% of CO2 in the blood
Dissolved CO2
112
3% of CO2 in the blood
Carbaminohemoglobin
113
Cl HCO3 exchange in the RBC
Chloride shift (using Band 3 Protein)
114
O2 affecting affinity of CO2/H to HgB
Haldane Effect
115
CO2/H affecting affinity of O2 to HgB
Both Effect
116
Haldane
Lungs
117
Bohr
Body tissues
118
Pulmonary circulation: Pressure
< systemic circulation
119
Pulmonary circulation: Resistance
< systemic circulation
120
Pulmonary circulation: Cardiac Output
= systemic circulation
121
Pulmonary BLood Flow: Supine
Same through the entire lung
122
Pulmonary blood flow: Standing
Lowest at the apex, high at the base
123
Effect of hypoxia (low PAO2) on pulmonary Arterioles
vasoconstriction
124
Causes of pulmonary global hypoxia vasoconstriction
High altitude, fetal circulation
125
Other lung vasoactive substances
TXA2
| PGI2
126
Causes bronchi constriction
Leukotrienes
127
Local alveolar capillary pressure < alveolar air pressure throughout the cycle
Zone 1
128
Local alveolar capillary systolic pressure > alveolar air pressure during systole but less than that during diastole
Zone 2
129
Local alveolar capillary pressure > alveolar air pressure throughout the cycle
Zone 3
130
No blood flow
Zone 1
131
Intermediate blood flow
Zone 2
132
Continuous blood flow
Zone 3
133
What lung zones do we see in the APEX of the lungs?
Zone 2, 3
134
What lung zones do we see in the BASE of the lungs?
Zone 3
135
What lung zones do we see in a supine position, or during exercise THROUGHOUT THE LUNGS?
Zone 3
136
What lung zones do we see in cases of PULMONARY HEMORRHAGE or POSITIVE PRESSURE VENTILATION?
Zone 1
137
Which one will show decrease in arteriole PO2 - Right-to Left Shunts or Left-to-Right Shunt?
Right to Left Shunts
138
What happens to Pulmonary Vascular resistance when baby takes first breath
Decrease
139
What happens to Pulmonary Blood Flow when baby takes first breath?
Increase
140
Normal V/Q ratio
0.8
141
Site of highest ventilation (V)
Base of the lungs
142
Site of Highest Perfusion (Q)
Base of the lungs
143
Site of highest V?Q Ratio
Apex of the lungs
144
Ventilated area of the Lungs with (-) Perfusion (V/Q = Infinity)
Dead Space (ex. Pulmonary Embolism)
145
Perfusion of Lungs with no Ventilation (V/Q - zero)
Shunt (ex. R-L shunt, airway obstruction)
146
Alveolar gas has same composition as humidified inspired air (PAO2 = 150 mmHg and PACO2 = 0 )
Dead space
147
Pulmonary capillary blood has same composition as mixed venous blood: PaO2 = 40 mmHg & PaCO2 = 46 mmHg)
Shunt
148
Compared with the apex of the lung, the base of the lung has
A higher pulmonary capillary PCO2
149
All of the following statements regarding the lungs are correct except?
A. Ventilation is higher at the apex lower at the base
b. Blood Flow is lowest at the apex and highest at the base
C. The V/Q ratio in the apex is higher than the base
D. Regional Arterial PaO2 is higher in the apex
E. Regional arterial PCO2 is higher in the base
A. Ventilation is higher at the apex lower at the base
| (base is higher)
150
How does moderate exercise affect pulmonary artery pressure and diffusion capacity?
Increased pulmonary artery pressure and diffusion capacity
151
Which of the following statement regarding the lung zones is not correct?
A. The base is the site of highest ventilation of the lungs
B. The base is the site of highest perfusion of the lungs
C. Zone 1 of the lungs is usually not seen in normal individuals
D. The base is the site of the highest V/Q ratioAn example of a shunt is airway obstruction
D. The base is the site of the highest V/Q ratio
152
Components from Control of Breathing
```
Cerebral cortex
Control centers in the midbrain and pons
Central and peripheral chemoreceptors
Mechanoreceptors
Respiratory muscles
```
153
Period of prior hyperventilation can prolong the duration of breath-holding
Cerebral Cortex
154
Creates the Basic Respiratory Rhythm
| Contains DRG, VRG and Central chemoreceptors
Medulla
155
Modifies the Basic Respiratory Rhythm
| Contains the Apneustic and Pneumotaxic centers
Pons
156
Inspiration centers control basic rhythm, for normal inspiration
Dorsal Respiratory Group DRG
157
Overdrive Mechanism during exercise, for Forced inspiration and expiration
Central Respiratory Group VRG
158
Found in the Lower pons for prolonged inspiratory gasp -> decreases respiratory rate
Apneustic center
159
Found in the Upper pons, limits time for inspiration -> increases respiratory rate
Pneumotaxic center
160
Found in ventral medulla
| Respond directly to CSF H (increase RR)
Central Chemoreceptors
161
Responds MAINLY to PaO2 < 70mmHfg (increases RR0
| Respond to high PaCO2, low pH
Peripheral Chemoreceptors
162
Carbon Dioxide
Central Chemoreceptors
163
42 year old woman with severe pulmonary fibrosis is evaluated by her physician and has the following arterial blood gases pH 7.48 PaO2 55 mmHg and PaCO2 32 mmHg, which statement best explains the observed value of PaCO2?
The decrease PaO2 stimulates breathing via peripheral receptors
164
Stimulated by Lung Distention
Lung Stretch Receptors
165
Initiates HeringBreuer Reflex that decreases Respiratory Rate by prolonging expiratory time
Lung Stretch Receptors
166
Stimulated by limb movement
Joint & Muscle Receptors
167
Causes anticipatory increase in respiratory rate during exercise
Joint & Muscle Receptors
168
Stimulated by noxious chemical
Irritant receptors
169
Causes bronchi constriction and increases the respiratory rate
Irritant receptors
170
Found in juxtacapillary area
J receptors
171
Stimulated by pulmonary capillary engorgment
J receptors
172
Causes rapid shallow breathing and responsible for the feeling of dyspnea (ex L-sided heart failure)
J receptors
173
No gas exchange
Conducting zone
174
Nose to terminal bronchioles
Conducting zone
175
With gas exchange
Respiratory zone
176
Respiratory bronchioles, alveolar ducts, alveolar sacs
Respiratory zone
177
How many generation of airways do you find in the respiratory system?
23
178
How many alveoli are present in the respiratory system?
500 million
179
500 ml
Tidal Volume
180
An atomic dead space
150 ml
181
Physiologic dead space
350 ml
182
Maintain oxygenation even in between breaths
Residual volume
183
Maximum amount exhale/inhale
VC / vital capacity
184
Alveolar pressure = atmospheric pressure (equilibrium
FRC
185
Left sided heart failure
Alveolar Macrophage
186
Associated with hemolysis
Bronchial blood vessels
187
What is the sympathetic effect on the smooth muscles of the airways?
Relaxation (Beta 2)
188
What is the parasympathetic effect on the smooth muscles of the airways?
Contraction (Muscarinic receptors)
189
For gas exchanges with 96 - 98% surface area
Type 1 pneumocyte
190
Small, cuboidal, found at the corners of alveoli, for surfactant production with 2-4% surface area
Type 2 pneumocyte
191
Keep alveoli free of dust and debris
Alveolar macrophages
192
In CHF: may convert to siderophages/ Hemosiderin-laden macrophages
Alveolar macrophages
193
Produce mucus
Goblet cells, submucosal glands
194
In COPD: hyperplasia, hypertrophic seen
Goblet cells, submucosal glands
195
May play a role in epithelial regeneration after injury by secreting protective GAGs
Clara Cells/ Club Cells
196
Carries DEOXYGENATED Blood to the lungs (respiratory bronchioles, alveolar ducts, alveoli)
Pulmonary Circulation
197
"Sheet" arrangement
Pulmonary Capillaries
198
Carries OXYGENATED BLOOD to the lungs (conducting airways & surrounding tissues)
Bronchial Circulation
199
Pulmonary veins returns to Left atrium alone
Pulmonary circulation
200
Capable of Angiogenesis
Bronchial circulation
201
1/3 returns to right atrium via bronchial veins
| 2/3 returns to the left atrium via pulmonary veins
Bronchial circulation
202
4 basic lung volumes
IRV
TV
ERV
RV
203
4 lung capacities
IC
FRCVC
TLC
204
Cannot be measured directly by spirometers
FRC
IRV
RV
TLC
205
Amount of air inspired/expired during quiet breathing
TV
206
Maintains oxygenation in between breaths
RV
207
Equilibrium/Resting volume of the lungs
FRC
208
Marker of Lung function
FRC
209
Differences among sexes
Lung volumes and capacities 20-25% lower in females
210
Factors that increase VC
Body size, male gender, conditioning, youth
211
Asthma, COPD,
Obstructive
212
Interstitial lung disease
Restrictive
213
Which of the following lung volumes or capacities can be measured by spirometers
Vital Capacity
214
Refers to the amount of air left in the lungs after a regular normal exhalation?
Functional residual capacity
215
Anatomic dead space + alveolar dead space
Physiologic dead space
216
Air in the conducting zone
Anatomic dead space (150 ml)
217
Air in the alveoli not participating in gas exchange due to V/Q mismatch
Alveolar Dead Space (9 mL)
218
Total rate of air movement in/out of the lungs
Minute Ventilation
219
Minute ventilation corrected for physiologic dead space
Alveolar Ventilation
220
What happens to the FEV1 and FVC in patients with obstructive and restrictive lung diseases?
Decreases
221
What is the FEV1/FVC ratio of a healthy person?
80%/ .8
222
What happens to the FEV1/FVC ratio in patients with obstructive and restrictive lung disease respectively
Obstructive: decreased
Restrictive: normal to increased
223
A 60 year old male patient came to the clinic complaining of exertion all dyspnea, he presents with some muscle wasting, increase anteroposterior diameter of the chest, O2 seats were 92% on ambient air auscultation revealed occasional wheezing on both lung basest (-) crackles, (-)bipedal edema, (-) Orthoptera, PND, patient is a known 40 pack year smoker. X-ray revealed hyper aerated lung fields, low set diaphragm. What is the expected finding in spirometers?
Decreased FEV1
224
All of the following are true statements pertaining to the patient above except?
A. There is decreased are for gas diffusion due to alveolar destruction
b. There is increased lung compliance
C. There is decreased lung recoil
D. There is decreased airway resistance due to loss of tethering effect
D. There is decreased airway resistance due to loss of tethering effect
225
His ABG reaves ad pH=7.35 PCO2 = 5- HCO3 28 PO2 90, which of the following is correct?
A. Has acute respiratory acidosis
B. Has acute respiratory alkalosis
C. There is a shift of the hemoglobin dissociation curve to the left
D. There is decreased affinity of hemoglobin to oxygen
D. There is decreased affinity of hemoglobin to oxygen
Do: respiratory acidosis with renal compensation
226
After a month, the patient had a severe exacerbation leading to acute respiratory failure which necessitated mechanical ventilators, patients condition was stabilized with latest ABG after 12 hours showed pH 7.47 PCO2 30 HCO3 24 PO2 95 Fi)2 40% VT 500 mL AC mode RR 16 PEEP 5. What is the next best step?
Decrease the RR to 12
227
Forced Inspiration
External intercostals, SCM, anterior serrati, scalene, Alae Nasir, genioglossus, arytenoid
228
Inspiration
Ribs upward and outward; abdominal contents downward
229
Forced Expiration
Internal intercostals, reclusive abdominal, internal and external oblique, transversus abdominis
230
Expiration
Ribs downward and inward, abdominal contents upward
231
```
Pathology: loss of elastic fiber
Compliance: increased
Elasticity: decreased
FRC: increased
Effects: barrel shaped chest
```
Emphysema
232
```
Pathology: stiffening of lung tissue
Compliance: decreased
Elasticity: increased
FRC: decreased
Effects:
```
Fibrosis
233
Force caused by water molecules at the air-liquid interface that tends to minimize surface area
SurfaceTension
234
Cell that produces surfactant
Type 2 pneumocyte
235
Main component of surfactant
Water
236
Active component of surfactant
Dipalmitoyl-phosphatidylcholine (DPPC) / Lecithin
237
Mechanism for DPPC reducing surface tension
Amphipathic nature (Hydrophobic and hydrophilic)
238
Effect of surfactant on lung compliance
Increase
239
Start of surfactant production
24th week AOG
240
Maturation of surfactant
35th week AOG
241
Test for surfactant
Amniotic L:S Ratio
242
Treatment for newborn RDS
Steroids, Surfactant
243
Airway resistance
Poiseuille's law
244
Major site of airway resistance
Medium-sized bronchi
245
Factors affecting Airway Resistance
Bronchial smooth muscle
Lung volume
Viscosity/density of inspired gas
246
Ability of the respiratory membrane to exchange gas between the alveoli and the pulmonary blood
Diffusing Capacity
247
Diffusing capacity for O2
At rest: 21 ml/min/mmHg
| Maximal Exercise: 65 ml/min/mmHg
248
Diffusing capacity for CO2
At rest: 400 - 450 ml/min/mmHg
| Maximal Exercise: 1200 - 1300 ml/min/mmHg
249
What are the forms of gases in solution?
Dissolved gas, bound gas, chemically modified gas
250
What is the only form of gas that contributes to partial pressure
Dissolved gas
251
What is the only gas in inspired air found exclussively as dissolved gas?
Nitrogen
252
Decrease in arterial PO2
Hypodermic
253
Used to compare causes of hypo emit
A-a gradient
254
Normal A-a gradient
< 10 mmHg
255
Decreased O2 deliver to the tissues
Hypoxia
256
Which of the following causes of hypoxia is characterized by a decreased arterial PO2 and an increased A-a gradient?
Right to left cardiac shunt
257
All of the following conditions causes both a decrease in PaO2 and increase in A-a gradient except?
A. Pulmonary fibrosis
B. V/Q of 0 or low V/Q state like airway obstruction
C. Right to left cardiac shunt
D. High altitude sickness
High altitude sickness
258
Gas equilibrates with the pulmonary capillary near the start of the pulmonary capillary
Diffusion of gas increased only by increasing blood flow
Perfusion-Limited Gas exchange
259
Gas does not equilibrates even until the end of the pulmonary capillary
CO and O2 during strenuous exercise and disease states (emphysema, fibrosis)
Diffusion-Limited Gas Exchange
260
O2 transport rest
Perfusion-Limited
261
O2 transport during exercise and diseased state
Diffusion-Limited
262
O2 transport in high altitude
Slow
263
Equilibration of O2 at sea-level
1/3 length of Pulmonary Capillary
264
Equilibration of O2 at high altitude
2/3 length of Pulmonary Capillary
265
Percentage of Dissolved O2
2%
266
Percentage of O2 bound to HgB
98%
267
HgB with attached O2
Oxyhemoglobin
268
HgB without attached O2
Deoxyhemoglobin
269
HgB with Fe3+; doesn't bind O2
Methemoglobin
270
a2y2, higher affinity for O2
Fetal hemoglobin (HbF)
271
aA2Bs2 sickles RBCs, less affinity for O2
Hemoglobin S
272
Max O2 binding with HgB
O2-binding capacity
273
% of blood that gives up its O2 as it passes through the tissues
Utilization Coefficient
274
Binding of first O2 molecule increases affinity for second O2 molecule and so forth
Exhibits Positive Cooperativity
275
Increased UNLOADING of O2 to HgB
Increased P50
Due to increased Carbon Dioxide, Acidosis, 2,3 BPG, Exercise, Temperature
Shift to the Right
276
Increased BINDING of O2 to HgB
Decreased P50
Due to Increased Carbon Monoxide, HbF
Shift to the Left
277
Cherry red appearance
CO poisoning
278
A patient was found one winter evening by her relatives at home in a comatose state right beside the gas heater, labs revealed normal PaO2 and O2 saturation of 97%, what is the most likely condition?
CO poisoning
279
The condition in the patient above causes which of the following physiologic effects?
Left shift of the oxyhemoglobin dissociation curve
280
In relation to the patient above, which of the following is true if P50 of HgB was found to have gone down to 20 mmHg?
Affinity of hemoglobin to O2 increases
281
90% of CO2 in the blood
HCO3
282
5% of CO2 in the blood
Dissolved CO2
283
3% of CO2 in the blood
Carbaminohemoglobin
284
Cl HCO3 exchange in the RBC
Chloride shift (using Band 3 Protein)
285
O2 affecting affinity of CO2/H to HgB
Haldane Effect
286
CO2/H affecting affinity of O2 to HgB
Both Effect
287
Haldane
Lungs
288
Bohr
Body tissues
289
Pulmonary circulation: Pressure
< systemic circulation
290
Pulmonary circulation: Resistance
< systemic circulation
291
Pulmonary circulation: Cardiac Output
= systemic circulation
292
Pulmonary BLood Flow: Supine
Same through the entire lung
293
Pulmonary blood flow: Standing
Lowest at the apex, high at the base
294
Effect of hypoxia (low PAO2) on pulmonary Arterioles
vasoconstriction
295
Causes of pulmonary global hypoxia vasoconstriction
High altitude, fetal circulation
296
Other lung vasoactive substances
TXA2
| PGI2
297
Causes bronchi constriction
Leukotrienes
298
Local alveolar capillary pressure < alveolar air pressure throughout the cycle
Zone 1
299
Local alveolar capillary systolic pressure > alveolar air pressure during systole but less than that during diastole
Zone 2
300
Local alveolar capillary pressure > alveolar air pressure throughout the cycle
Zone 3
301
No blood flow
Zone 1
302
Intermediate blood flow
Zone 2
303
Continuous blood flow
Zone 3
304
What lung zones do we see in the APEX of the lungs?
Zone 2, 3
305
What lung zones do we see in the BASE of the lungs?
Zone 3
306
What lung zones do we see in a supine position, or during exercise THROUGHOUT THE LUNGS?
Zone 3
307
What lung zones do we see in cases of PULMONARY HEMORRHAGE or POSITIVE PRESSURE VENTILATION?
Zone 1
308
Which one will show decrease in arteriole PO2 - Right-to Left Shunts or Left-to-Right Shunt?
Right to Left Shunts
309
What happens to Pulmonary Vascular resistance when baby takes first breath
Decrease
310
What happens to Pulmonary Blood Flow when baby takes first breath?
Increase
311
Normal V/Q ratio
0.8
312
Site of highest ventilation (V)
Base of the lungs
313
Site of Highest Perfusion (Q)
Base of the lungs
314
Site of highest V?Q Ratio
Apex of the lungs
315
Ventilated area of the Lungs with (-) Perfusion (V/Q = Infinity)
Dead Space (ex. Pulmonary Embolism)
316
Perfusion of Lungs with no Ventilation (V/Q - zero)
Shunt (ex. R-L shunt, airway obstruction)
317
Alveolar gas has same composition as humidified inspired air (PAO2 = 150 mmHg and PACO2 = 0 )
Dead space
318
Pulmonary capillary blood has same composition as mixed venous blood: PaO2 = 40 mmHg & PaCO2 = 46 mmHg)
Shunt
319
Compared with the apex of the lung, the base of the lung has
A higher pulmonary capillary PCO2
320
All of the following statements regarding the lungs are correct except?
A. Ventilation is higher at the apex lower at the base
b. Blood Flow is lowest at the apex and highest at the base
C. The V/Q ratio in the apex is higher than the base
D. Regional Arterial PaO2 is higher in the apex
E. Regional arterial PCO2 is higher in the base
A. Ventilation is higher at the apex lower at the base
| (base is higher)
321
How does moderate exercise affect pulmonary artery pressure and diffusion capacity?
Increased pulmonary artery pressure and diffusion capacity
322
Which of the following statement regarding the lung zones is not correct?
A. The base is the site of highest ventilation of the lungs
B. The base is the site of highest perfusion of the lungs
C. Zone 1 of the lungs is usually not seen in normal individuals
D. The base is the site of the highest V/Q ratioAn example of a shunt is airway obstruction
D. The base is the site of the highest V/Q ratio
323
Components from Control of Breathing
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Cerebral cortex
Control centers in the midbrain and pons
Central and peripheral chemoreceptors
Mechanoreceptors
Respiratory muscles
```
324
Period of prior hyperventilation can prolong the duration of breath-holding
Cerebral Cortex
325
Creates the Basic Respiratory Rhythm
| Contains DRG, VRG and Central chemoreceptors
Medulla
326
Modifies the Basic Respiratory Rhythm
| Contains the Apneustic and Pneumotaxic centers
Pons
327
Inspiration centers control basic rhythm, for normal inspiration
Dorsal Respiratory Group DRG
328
Overdrive Mechanism during exercise, for Forced inspiration and expiration
Central Respiratory Group VRG
329
Found in the Lower pons for prolonged inspiratory gasp -> decreases respiratory rate
Apneustic center
330
Found in the Upper pons, limits time for inspiration -> increases respiratory rate
Pneumotaxic center
331
Found in ventral medulla
| Respond directly to CSF H (increase RR)
Central Chemoreceptors
332
Responds MAINLY to PaO2 < 70mmHfg (increases RR0
| Respond to high PaCO2, low pH
Peripheral Chemoreceptors
333
Carbon Dioxide
Central Chemoreceptors
334
42 year old woman with severe pulmonary fibrosis is evaluated by her physician and has the following arterial blood gases pH 7.48 PaO2 55 mmHg and PaCO2 32 mmHg, which statement best explains the observed value of PaCO2?
The decrease PaO2 stimulates breathing via peripheral receptors
335
Stimulated by Lung Distention
Lung Stretch Receptors
336
Initiates HeringBreuer Reflex that decreases Respiratory Rate by prolonging expiratory time
Lung Stretch Receptors
337
Stimulated by limb movement
Joint & Muscle Receptors
338
Causes anticipatory increase in respiratory rate during exercise
Joint & Muscle Receptors
339
Stimulated by noxious chemical
Irritant receptors
340
Causes bronchi constriction and increases the respiratory rate
Irritant receptors
341
Found in juxtacapillary area
J receptors
342
Stimulated by pulmonary capillary engorgment
J receptors
343
Causes rapid shallow breathing and responsible for the feeling of dyspnea (ex L-sided heart failure)
J receptors
