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Respiratory Block > Respiratory Physiology 1-5 > Flashcards

Respiratory Physiology 1-5 Flashcards

1
Q

What is the upper respiratory system composed of?

A

The mouth, nasal cavity, pharynx and larynx.

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2
Q

What is the lower respiratory system composed of?

A

Trachea, bronchi and lungs.

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3
Q

What are characteristics of the right lung?

A

Composed of three lobes and a wider, more vertically oriented bronchi.

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4
Q

What are characteristics of the left lung?

A

Composed of two lobes and a narrower bronchi.

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5
Q

Which bronchii is more prone to issues?

A

The right bronchi as it is more vertically oriented which increases the risk of foreign bodies becoming trapped.

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6
Q

What are the different classes of airways?

A

Bronchi- conducting airways with cartilage.
Bronchioles- conducting airways without cartilage.
Alveoli- non-conducting airways participating in gas exchange.

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7
Q

What are the two types of alveolar cells and their associated functions?

A

Type 1- responsible for gas exchange.
Type 2- synthesise surfactant.

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8
Q

List the functions of the respiratory system.

A

Gas exchange.
Maintaining acid-base balance (regulation of pH).
Protection from infection.
Communication via speech.

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9
Q

What is the difference between pulmonary and systemic circulation?

A

The pulmonary circulation delivers carbon dioxide to the lungs and collects.
The systemic circulation delivers oxygen to the peripheral tissues and collects carbon dioxide.

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10
Q

What does the pulmonary artery carry?

A

Deoxygenated blood away from the heart to the lungs.

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11
Q

What does the pulmonary vein carry?

A

Oxygenated blood from the lungs towards the heart.

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12
Q

Identify points of gas exchange between the respiratory and cardiovascular systems.

A

Gas exchange only occurs in the alveoli, which are in direct contact with capillaries of the CV system.

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13
Q

Understand why, and how, resistance to air flow varies across the respiratory tree.

A

As the airways narrow, the resistance to airflow becomes greater.
Resistance to air flow can be altered by activity of bronchial smooth muscle.

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14
Q

What is tidal volume? how many ml?

A

The volume of air breathed in and out of the lungs at each breath.
500ml

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15
Q

What is the expiratory reserve volume?

A

The maximum volume of air which can be expelled from the lungs at the end of a normal expiration.

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16
Q

What is the inspiratory reserve volume?

A

The maximum volume of air which can be drawn into the lungs at the end of a normal inspiration.

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17
Q

What is the residual volume?

A

The volume of gas in the lungs at the end of a maximal expiration.

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18
Q

Describe the anatomy of the pleural cavity?

A

The lungs and interior of the thorax are covered by pleural membranes between the surfaces which is an extremely thin layer of intrapleural fluid.

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19
Q

Describe the relationship between the visceral and parietal pleura.

A

The visceral pleura is stuck to the outer surface of the lungs.
The parietal pleura is stuck to the ribcage and diaphragm.
The visceral and parietal pleura are stuck together via the cohesive forces of the pleural fluid.

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20
Q

del

A

del

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21
Q

What are the muscles involved with inspiration and what do they do?

A

External intercostal muscles.
The diaphragm.
Accessory muscles (e.g. sternocleidomastoid).
-Act to increase thoracic volume.

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22
Q

What are the muscles involved with expiration and what do they do?

A

Expiration is passive at rest but uses internal intercostal and abdominal muscles during severe respiratory load.
-Act to decrease thoracic volume.

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23
Q

What does Boyle’s Law state?

A

Boyle’s law states that the pressure exerted by a gas is inversely proportional to its volume.

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24
Q

Relate Boyle’s law to inspiration.

A

During inspiration, the increase in thoracic volume will cause a decrease in pressure within the lung, causing air at atmospheric pressure to rush into the lungs.

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25
Q

Relate Boyle’s law to expiration.

A

During expiration, a decrease in thoracic volume increases the pressure within the lungs. This causes air to rush out of the lungs.

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26
Q

What is alveolar pressure (PA)?

A

The alveolar pressure (PA) is the pressure inside the thoracic cavity, (essentially pressure inside the lungs). It may be negative or positive compared to the atmospheric pressure.

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27
Q

What is the intrapleural pressure (Pip)?

A

The intrapleural pressure (Pip) is the pressure inside the pleural cavity, typically negative compared to the atmospheric pressure (in healthy lungs).

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28
Q

What is the transpulmonary pressure (PT)?

A

The transpulmonary pressure (Pt) is the difference between the two. Almost always positive as Pip is negative (in health). Pt= Palv – Pip.

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29
Q

State the role of pulmonary surfactant.

A

The surfactant is a detergent-like fluid that reduces surface tension on the alveolar surface membrane thus reducing the tendency for alveoli to collapse. due to surface tension.

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30
Q

Does surfactant increase lung compliance (distensibility)?

A

Yes, it it reduces the lungs tendency to recoil and makes breathing easier.

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31
Q

Is surfactant more effective in smaller or larger alveoli?

A

Smaller alveoli because the surfactant molecules come closer together and are therefore more concentrated.

32
Q

Describe Dalton’s Law

A

The total pressure by gaseous mixture = sum of all partial pressures of gases in the mixture.

33
Q

Define the term compliance.

A

Compliance is the change in volume relative to the change in pressure.
It represents the stretchability of the lungs (not the elasticity!).

34
Q

What factors affect compliance?

A

Elastic fibres and surface tension of the lungs.
More elastic fibers in the tissue lead to ease in expandability and, therefore, compliance. Surface tension within the alveoli is decreased by the production of surfactant to prevent collapse.

35
Q

What is the functional difference between pulmonary and alveolar ventilation?

A
  • Pulmonary (minute) ventilation = total air movement into/out of the lungs (relatively insignificant in functional terms).
  • Alveolar ventilation = fresh air getting to alveoli and therefore available for gas exchange (functionally more significant).
36
Q

Define dead space and give the anatomical volume.

A

Dead space is the volume of gas occupied by the conducting airways and this gas is not available for exchange.
150ml

37
Q

Describe the impact of dead space on alveolar ventialtion.

A

Increases in dead space could have a detrimental impact on alveolar ventilation as less fresh air reaches the alveoli to allow for gas exchange.

38
Q

What are the alveolar and arterial gas partial pressures?

A

PO2 = 100 mm Hg or 13.3 kPa.
PCO2 = 40 mm Hg or 5.3kPa.

39
Q

What are the gas partial pressures in the pulmonary artery?

A

PO2= 40 mm Hg.
PCO2= 46 mm Hg.

40
Q

Describe the blood supply to the lungs.

A

The lungs receive a blood supply via bronchial and pulmonary circulation. The bronchial supply is part of the systemic circulation and arises from the left side as oxygenated blood. The pulmonary circuit is involved in gas exchange and receives the output from the right heart.

41
Q

What factors influence the diffusion of gases across the alveoli?

A
  • The rate of diffusion across the membrane is:
    o Directly proportional to the partial pressure gradient.
    o Directly proportional to gas solubility.
    o Directly proportional to the available surface area.
    o Inversely proportional to the thickness of the membrane.
    o Most rapid over short distances.
42
Q

What are the abbreviation for alveolar, arterial blood and mixed venous blood?

A
  • A- alveolar.
  • a- arterial blood.
  • ṽ- mixed venous blood (e.g. in pulmonary artery).
43
Q

How does emphysema impact gas exchange?

A

Destruction of the alveoli reduces the surface area available for gas exhange.

44
Q

How does fibrotic lung disease impact gas exchange?

A

The thickened alveolar membrane slows gas exchange. Loss of lung compliance may decrease alveolar ventilation.

45
Q

How does pulmonary edema impact gas exchange?

A

Fluid in the interstitial space increases diffusion distance. Arterial PCO2 may be normal due to higher CO2 solubility in water.

46
Q

How does asthma impact gas exchange?

A

Increased airway resistance decreases airway ventilation.

47
Q

What is restrictive lung disease and give examples.

A
  • Restrictive lung disease includes conditions that make it difficult to fully expand the lungs with air. Examples include asbestosis, sarcoidosis and pulmonary fibrosis.
48
Q

What is obstructive lung disease and give examples.

A
  • Obstructive lung diseases include conditions that make it difficult to exhale all the air in the lungs. Examples include asthma, COPD, cystic fibrosis, and bronchiectasis.
49
Q

What main symptoms do restrictive and obstructive lung diseases share?

A

Shortness of breath with exertion.

50
Q

Outline how spirometry can be used to identify abnormal lung function.

A
  • Spirometry is a method of assessing lung function by measuring the volume of air that the patient is able to expel from the lungs after a maximal inspiration. It is a reliable method of differentiating between obstructive airways disorders (e.g. chronic obstructive pulmonary disease, asthma) and restrictive diseases (e.g. fibrotic lung disease).
51
Q

What measures does spirometry provide?

A

o Forced expiratory volume in 1s (FEV1): the volume exhaled in the first second after deep inspiration and forced expiration, similar to PEFR.
o Forced vital capacity (FVC): the total volume of air that the patient can forcibly exhale in one breath.
o FEV1/FVC: the ratio of FEV1 to FVC expressed as a percentage. normal (>0.7).

52
Q

What spirometry findings would you expect from a patient with obstructive lung disease?

A

o Reduced FEV1 (<80% of the predicted normal).
o Reduced FVC <80% (but to a lesser than FEV1).
o FEV1/FVC ratio reduced (<0.7).

53
Q

What spirometry findings would you expect from a patient with restrictive lung disease?

A
  • Reduced FEV1 (<80% of the predicted normal).
  • Reduced FVC (<80% of the predicted normal).
  • FEV1/FVC ratio normal (>0.7).
54
Q

What does the oxyhaemoglobin dissociation curve show?

A

The relationship between haemoglobin oxygen saturation (%) and the partial pressure of oxygen.

55
Q

What is positive cooperativity?

A

Deoxyhaemoglobin exists in a tense state and binding of oxygen occurs with low affinity. The binding of a single oxygen to a heme subunit induces a conformational change that causes the haemoglobin molecule to form a relaxed state, with a higher affinity for oxygen binding. The binding of the first oxygen allows the second, third and fourth oxygen to bind with increasing ease.

56
Q

Explain why the shape of the deoxyhaemoglovin dissociation curve is important to O2 loading in the lungs and unloading in the tissues.

A

The sigmoid or S-shape curve is due to the positive cooperativity of haemoglobin. In the pulmonary capillaries, the partial pressure of oxygen is high allowing more oxygen molecules to bind haemoglobin until reaching the maximal concentration. At this point, little additional binding occurs and the curve flattens out representing hemoglobin saturation. At the systemic capillaries, pO2 is lower and can result in large amounts of oxygen released by hemoglobin for metabolically active cells, which is represented by a steeper slope of the dissociation curve.

57
Q

Describe the factors that shift the deoxyhaemoglobin curve to the right (decreased affintiy). Hint: CADET face Right.

A

-Increased PCO2.
-Increased acidity (decreased pH).
-Increased binding of 2,3 DPG.
-Increased exercise.
-Increased temperature. `

58
Q

Describe the factors that shift the deoxyhaemoglobin curve to the left (increased affinity).

A
  • Decreased PCO2.
  • Decreased acidity (increased pH).
  • Decreases binding of 2,3 DPG.
    -Decreased temperature.
59
Q

Compare the oxyhaemoglobin dissociation curve for adult haemoglobin with that of foetal haemoglobin and myoglobin in relation to their physiological roles.

A

Foetal haemoglobin and myoglobin have a higher affinity for O2 than adult haemoglobin as this is necessary for extracting O2 from maternal/arterial blood.

60
Q

Identify the forms in which CO2 is carried in the blood.

A
  • When CO2 molecules diffuse from the tissues into the blood:
    o 7% remains dissolved in plasma and erythrocytes.
    o 23% combines in the erythrocytes with deoxyhaemoglobin to form carbamino compounds.
    o 70% combines in the erythrocytes with water to form carbonic acid.
61
Q

Explain the role of carbonic anhydrase in CO2 transport.

A
  • Carbonic anhydrase aids in the conversion of carbon dioxide to carbonic acid and bicarbonate ions.
  • When red blood cells reach the lungs, the same enzyme helps to convert the bicarbonate ions back to carbon dioxide which we breathe out.
62
Q

Define the term shunt.

A

Shunt is a term used to describe the passage of blood through areas of the lung that are poorly ventilated (ventilation < perfusion). This is the opposite to alveolar dead space.

63
Q

Define the term alveolar dead space.

A

Alveolar dead space refers to alveoli that are ventilated but not perfused.

64
Q

Define the term anatomical dead space.

A

Anatomical dead space refers to air in the conducting zone of the respiratory tract unable to participate in gas exchange.

65
Q

Define the term physiological dead space.

A
  • Physiological dead space = alveolar DS + anatomical DS.
66
Q

What is the physiological response to ventilation < perfusion (ratio 1.0).

A

Alveolar PO2 falls, PCO2 rises.
Pulmonary vasoconstriction and bronchial dilation occur.

67
Q

What is the physiological response to ventilation > perfusion (ratio 1.0).

A

Alveolar PO2 rises, PCO2 falls.
Pulmonary vasodilation and bronchial constriction occur.

68
Q

What does Boyle’s law describe?

A

Describes how the pressure of a gas increases as container volume decreases.
Inspiration > increase in lung volume > pressure decreases.
Expiration > decrease in lung volume > pressure increases.

69
Q

what is the functional residual capacity?

A

expiratory reserve volume + residual volume

70
Q

what is the vital capacity?

A

tidal volume + expiratory reserve volume + inspiratory reserve volume

71
Q

how do you calculate minute ventialtion?

A

tidal volume x respiratory rate
VT x RR

72
Q

discuss the sequence of events in passive inhalation

A

negative pressure inside body generated > moves air into lungs.
increase in thoracic volume > decrease in intrathoracic (alveolar) pressure.
air move into lungs > moves down a pressure gradient.

73
Q

discuss the sequence of events in passive exhalation

A

increase in intrathoracic (alveolar) pressure > moves air out of lungs.
decrease in thoracic volume > increase in alveolar pressure.
air is pushed out of lungs

74
Q

between breaths, after an unforced expiration, what are the lung pressures?

A

alveolar pressure = atmospheric pressure
intrapleural pressure = sub-atmospheric
transpulmonary pressure = positive

75
Q

describe the pressure changes during inspiration

A

Contraction of inspiratory muscles > increase in thoracic volume.
Intrapleural pressure more negative (subatmospheric) > lungs expand.
Expansion > alveolar pressure becomes subatmospheric > pressure difference between atmosphere and alveoli > drives air into lungs.

76
Q

describe the pressure changes during expiration

A

recoil of lungs > decreases thoracic volume.
alveolar pressure > atmospheric pressure.
air is driven out of the lungs.

Respiratory Block (10 decks)

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