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Respiratory Physiology > Respiratory Physiology > Flashcards

Respiratory Physiology Flashcards

1
Q

To inhale and exhale

A

respire

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2
Q

Physiological components of respiration

A

transport of oxygen from ambient air to tissue cells and transport of CO2 from tissue to air; combo of airflow and gas exchange

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3
Q

4 phases of respiration

A

ventilation, diffusion, transport, diffusion

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4
Q

How does the architecture of the lung subserve respiratory function?

A

conduction (for ventilation)

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5
Q

How many lobes on the left lung?

A

2; upper and middle lobes

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6
Q

How many lobes on the right lung?

A

3; UL, ML, LL

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7
Q

Bulk flow in the conducting apparaturs occurs in response to

A

Pressure gradient

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8
Q

How many generations

A

23

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9
Q

Generations: Trachea

A

z,0

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10
Q

Generations: bronchi

A

1-3

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11
Q

Generations: Bronchioles

A

4

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12
Q

Generations: Terminal bronchioles

A

5-16

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13
Q

Generations: Respiratory bronchioles

A

17-19

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14
Q

Generations: Alveolar ducts

A

20-22

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15
Q

Generations: alveolar sacs

A

23

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16
Q

flow is affected by

A

frictional resistance, shape of the conduit and the nature of the gas

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17
Q

Conducting zone consists of

A

trachea, bronchi, bronchioles, terminal bronchiloes

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18
Q

Transitional and respiratory zones consist of

A

respiratory bronchioles, alveolar ducts, alveolar sacs

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19
Q

Optimizing velocity of air flow

A

Conducting zone:fast, respiratory zone: slow

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20
Q

Delta P

A

flow or volume/ time occurs in response to pressure gradient

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21
Q

flow= pressure difference/ Resistance

A

aka Ohm’s law

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22
Q

Pressure =

A

force/area

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23
Q

Optimizing velocity of airflow

A

flow=deltaP/resistance; pressure=force/area; cross sectional area increases, pressure gradient decreases and velocity of flow decreases; exchange can occur; conducting airways: trachea and bronchi - very high; respiratory zone, compromises respiratory bronchioles and alveolar ducts

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24
Q

How does the architecture of the lung subserve respiratory function?

A

diffusion

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25
Q

Maximizing gas exchange

A

o2 and co2 move from air to blood by simple diffusion in response to pressure gradient aka ficks law

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26
Q

Fick’s law

A

o2 and co2 move from air to blood by simple diffusion in response to pressure gradient

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27
Q

Vgas=Area/thickness x D x pressure difference

A

ficks law

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28
Q

d=solubility/square root of molecular weight

A

D

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29
Q

O2 and CO2 move from air to blood by

A

simple diffusion in response to pressure gradient

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30
Q

CO2 is more diffusable than

A

O2 by about 20x

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31
Q

PaCO2 AND P ACO2 is nearly

A

identical

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32
Q

A-A gradient

A

5-10mmHg

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33
Q

Ohm’s law

A

flow = pressure difference/resistance

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34
Q

Airflow: Resistance is maximum in the ____ generation of airways

A

7th

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35
Q

Vascular flow: pulmonary vascular system is a ____ resistance circuit

A

low

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36
Q

Factors increasing airway resistance:

A 
forced expiration
beta blockers
histamine
acetylcholine
decreased lung volumes
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37
Q

Factors DECREASING airway resistance

A

increased lung volumes
heliox
beta stimulants

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38
Q

How does Heliox decrease airway resistance?

A

Decreases reynolds number by decreasing the gas

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39
Q

alveolar vessels are within the

A

alveolus

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40
Q

At high lung volumes, as the lung stretches, the vessels in the wall stretch and get thin … An analogy is

A

fish net stocking

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41
Q

Extra Alveolar vessels: all arteries and veins that run through

A

lung parenchyma

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42
Q

As the lungs expand, the vessels pull apart =

A

extra alveolar resistance

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43
Q

extra alveolar vessels

A

reduces resistance

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44
Q

an analogy for extra alveolar resistance

A

sponge - seinfield

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45
Q

Vascular resistance increases at

A

extremes of low and high lung volumes

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46
Q

need optimum lung volumes to maintain

A

perfect vascular resistance

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47
Q

When extra alveolar resistance increases will …. lung volume

A

decrease (squashed down)

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48
Q

When pulled apart

A

the alveolar resistance increases

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49
Q

Factors increasing pulmonary vascular resistance

A

increased lung volumes (alveolar)
decreased lung volume (extra alveolar)
lung disease
persistant pulmonary HTN of the newborn (full term)

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50
Q

Factors DECREASING pulmonary vascular resistance

A

oxygen

nitric oxide

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51
Q

Problem of pulmonary vascular resistance of preterm baby

A

lack of surfactant

respiratory stress syndrome

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52
Q

Surfactant gets produced around ___ gestational weeks

A

around 32

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53
Q

Oxygen and Nitric Oxide are potent

A

vasodilators

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54
Q

What does hypoxemia do to pulmonary vascular resistance?

A

increases resistance

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55
Q

Hypoxic pulmonary vasoconstriction

A
  • diverts blood flow from hypoxic to non-hypoxic lung areas

- is reduced by increasing intravascular resistance

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56
Q

When the lung sees some of it is hypoxic

A

the lung will divert blood away from the hypoxic area

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57
Q

In RDS, the lung tends to collapse due to

A

surface tension

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58
Q

Surfactant lines up on a

A

gas-liquid-surface interface

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59
Q

Fill up a lung with saline, there will be no

A

surface tension bc no interface

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60
Q

need surfactant to

A

push each other away which is why it works best with low lung volumes

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61
Q

Inhaled nitric oxide

A

does not drop blood pressure bc it binds to Hgb

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62
Q

During forced inspiration/expiration, you create a

A

choke point

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63
Q

A choke point does what?

A

direct squashing of the airway by the increased thoracic pressure before flowing on through any type of resistance

64
Q

beyond the choke point, is effort independent or dependent?

A

effort independent

65
Q

Which part of the slope do we use when assessing pulmonary function of a patient on a bronchdilator?

A

expiration

66
Q

Compliance

A

change in volume for a given change in pressure (high compliance=everything will blow up easy)

67
Q

compliance equation

A

difference in volume / difference in pressure

68
Q

increasing negative pressure around the lung will …

A

increase expansion

69
Q

surfactant contributes to

A

hysteresis

70
Q

hysteresis

A

more compliance on deflation. at any given pressure there will be a larger volume on deflation and actually speaks to elastic recoil

negative pressure pulls the lung apart

71
Q

If I increase negative pressure around the lung, would that enhance expansion?

A

yes

72
Q

Why do these changes occur between the apex and the base?

A

gravity

73
Q

which is aerated better: apex or base?

A

apex

74
Q

Which one is more responsive to a change in pressure?

A

base

75
Q

Ventilation is Increased or decreased at the base compared to the apex?

A

increased

76
Q

what happens if the pt is lying down?

A

sandwiched

77
Q

Both Ventilation and perfusion go down from base to apex but ventilation goes down more so what happens to the V/Q ratio?

A

it goes up

78
Q

v goes down, q goes down, v goes down more so

A

v/q ratio goes up

79
Q

What can NOT be measured by spirometery?

A

anything with residual volume, FRC

80
Q

anatomic dead space

A 
volume in CONDUCTING airways
about 150mL/breath
N2 washout technique
individual breaths through a valve box
eliminated air N2 is continuously sampled
81
Q

ADS is derived

A

the midpoint of transition form dead space to alveolar gas

82
Q

ADS

A

When we give someone 100% O2, it displaces the N2 and then we analyze this Nitrogen and plot it against a graph and when 50% of the Nitrogen is excreted we can get a volume that maybe tells you the non exchange in gas in the lungs based on nearly what was initiated in the airways

83
Q

do we all have ADS?

A

YES

84
Q

In a perfect world, anatomic dead space and physiological dead space would be the

A

same

85
Q

In asthma, increased dead space, lots of gas flow, very little air flow, very little vascular flow, no exchange =

A

physiological dead space increases

86
Q

Nitrogen washout for residual volume

A 
body does not produce N2
breathe 100%
collect expired air
measure expired nitrogen content
Air has 80% N2, so multiply by 1.25
87
Q

FRC measurement

A

Helium: Gas dilution technique (sugar bucket/cup)
subject connected to spirometer, containing a known concentration of helium
Helium is insoluble in blood
take a few breaths: equilibration
C1,V1= C2(V1+V2) = C2V1 +C2V2
V2 = V1( C1-C2)/C2

88
Q

Helium

A

Helium is insoluble in blood

89
Q

FRC: EQUILIBRATION equation

A 
C1,V1= C2(V1+V2) = C2V1 +C2V2
V2 = V1( C1-C2)/C2
90
Q

FRC does not give you what is behind trapped airways but it does give you…

A

what is being communicated

91
Q

FRC measurement by body plethysmogram

A 
large airtight box
Close the shutter after a few breaths
Subject breathes int a closed mouthpiece
Subject breathes in
2 Box pressures: before and after inspiration (P1 AND P2)
v1 - Preinspiratory box volume
Delta V = change in volume of the box

P1V1 = P2(V1-difference in volume)

2 Mouth pressures before and after inspiratory effort (P3 AND P4)

V2 is FRC

92
Q

FRC measurement by body plethysmogram

A

Will tell you how much gas is behind closed airways (the gas that is trapped) ; the way you measure it is by how much the lung expands

93
Q

Calculate dead space

A

Arterial CO2 - expired CO2

94
Q

Diffusion of oxygen is

A

efficient

95
Q

Diffusion of oxygen is efficient:

A 
pressure drop
Soluble
Thin membrane
Less Dense
PaO2 ~ 40mmHg
PAO2 ~ 100 mmHg
96
Q

Oxygen transfer is thus

A

perfusion limited

97
Q

Diffusion limitation

A

Oxygen delivery to tissues depends on perfusion
Diffusion limitation can be overcome by increasing pO2 in the alveolus, if the alveolus is perfused
Increase in pO2 in alveolus will increase gradient and increase arterial pO2
This can be done by increasing inspired O2

98
Q

If you have a 100% shunt can you overcome it?

A

no

99
Q

100% shunt V/Q =

A

0

100
Q

Blood that enters the arterial system without going through ventilated areas of the lung in other words

A

do not exchange gas

101
Q

100% shunt v/q=0: physiological

A

bronchial circulation and coronary circulation;

102
Q

100% shunt v/q = 0: pathological

A

communications rt to left by passing lung

103
Q

100% cardiac shunt can not be reversed by

A

oxygen

104
Q

physiological shunts

A

cause a difference between A-a gradient

Normal 5-10mmHg with breathing quietly

105
Q

Normal mmHg for A-a gradient

A

5-10 mmHg

106
Q

if you increase your pressures too much on the ventilator what do you end up with ?

A

dead space physiology - you squashed the alveoli vessels
Low etco2 bc very little return of CO2 to the blood bc you squashed off the vessel
HIGH arterial blood exchange

107
Q

if you have an adult with a collapsed lung, and you say well its a shunt …

A

it may help some bc it may decrease pulmonary vasoconstriction in some areas or enhance flow to some of the hypoxic areas that respond to oxygen

108
Q

A-a gradient: Pt received a bunch of morphine, is supposed to breath at 20bpm but now is breathing at 10 bpm, what do we think happened to the patient’s CO2?

A

it went up by exactly mathematically double (from 40 to 80)

109
Q

A-a gradient: Pt received a bunch of morphine, is supposed to breath at 20bpm but now is breathing at 10 bpm, what do we think happened to the patient’s CO2? (DOUBLED) How does oxygen help this patient?

A

you apply the alveolar gas equation.
The central chemoreceptors are down regulated bc the CO2 is going down and he is not responding bc he knocked out by the morphine … Alveolar available oxygen went down bc you subtracted it

110
Q

A-a gradient in hypoxemia: Normal:

A

Low inspired O2
Hypoventilation

oxygen helps

111
Q

A-a gradient in hypoxemia: increased

A

diffusion limitation
Ventilation-perfusioon inequality

oxygen helps

112
Q

A-a gradient in hypoxemia: shunt

A

oxygen does not help

113
Q

Dead Space - shunt

A 
ASD
VSD
PULMONARY 
-Mixed venous point 
V/Q= 0
114
Q

Dead Space-

A

Pulmonary Embolism
Inspired gas point
V/Q - a

cardiac arrest

115
Q

Ventilation - perfusion relationship

A

ventilation goes down from base to apex

116
Q

West Zones - 1

A

alveolar pressure : well aerated APEX

117
Q

West Zones 2-3

A

arterial pressure (base - most likely to shunt at base) is greater than alveolar pressure is greater than venous pressure … zone 2 LVEDP can be calculated

118
Q

West Zone 4

A

very little blood flow; vascular resistance goes up a lot when lung is collapsed in this zone

119
Q

Alveolar gas equation

A

pAlveolar o2 = FiO2 x 713 - pACO2 (same as paCO2) x RQ

120
Q

In room air FiO2

A

21% or 0.21

121
Q

Partial pressure of water vapor

A

47mmHg

122
Q

Barometric pressure of atmosphere

A

760 mmHg

123
Q

PaO2 is measured

A

arterial O2

124
Q

The difference (pAO2-paO2) is the

A

A-a gradient

125
Q

Arterial oxygen content equation

A

Hb(g/dl) x 1.36 x %sat + pao2 x 0.003

126
Q

Arterial oxygen delivery equation

A

Content x CO

Tells you how much oxygen you are getting in the tissues

127
Q

o2 dissociation curves: shift to the right

A

exercise, high CO2, hyperthermina, fever, acidosis

128
Q

o2 dissociation curves: shift to the left

A

carbon monoxide, alkalosis

129
Q

O2 dissociation curve: decreased

A

2-3dgp

130
Q

peripheral chemoreceptors

A

sensitive to blood not CSF

131
Q

Haldane effect

A

the deoxygenation of Hb helps loading of CO2 from tissue to blood

132
Q

HALDANE EFFECT: the dissociation curve for co2 in blood IS

A

LINEAR

133
Q

HALDANE EFFECT: it is shifted to the left when Hgb is in the form of deoxyhemoglobin, as in

A

venous blood

134
Q

Haldane effect: as a result, Hgb is deoxygenated in systemic capilaries, its affinity for CO2 is increased, facilitating CO2 transport AND

A

the bind affinity for H+ (generated in RBC along with HCO3-) is also increased

135
Q

Haldane effect: in pulmonary circulation, as hgb is oxygenated, its affinity for CO2 is reduced, and as a result, transfer of CO2 from blood to alveolar air is

A

facilitated

136
Q

CO2 transport affects acid-base

A

profoundly

137
Q

a rise in pCO2 invariable causes an increase

A

in alveolar ventilation (metabolic activity)

138
Q

Lung excretes ….. carbonic acid/day

A

10.000 mEq

139
Q

kidney excretes less than …. fixed acids/day

A

100 mEq

140
Q

Altering alveolar ventilation to get rid of CO2 control over

A

acid-base balance

141
Q

Respiratory acidosis

A

low pH, increase pCO2, increased Bicarb

breath holding infant, snoring adult

142
Q

Respiratory alkalosis

A

high pH, decreased pCO2, decreased bicarb

hysterical teenager

143
Q

Metabolic acidosis

A

decreased pH, decreased bicarb, decreased pCO2

DKA

144
Q

Metabolic alkalosis

A

increased pH, increased bicarb, increased pCO2

diuretic, vomiting

145
Q

Anion gap

A

used to differentiate between acidosis resulting from acid gain and acidosis caused by bicarbonate loss; difference between major cation, Na, and the major plasma anions, Cl and HCO3. When Cl and HCO3 are subtracted form the Na concentration, the anion gap is normally ~8-12 mEq.
AG= Na - (Cl + HCO3)

146
Q

AG: INCREASED

A

DKA, Lactic Acidosis, Uremia, Methyl Alcohol poisoning

147
Q

AG: decreased:

A

heavy metal poisoning

148
Q

AG: normal

A

renal diseases
from the gut
abnormal bicarbonate losses

149
Q

Clinical applications: PFT

A

FVC decreased in obstructive and restrictive
FEV1 decreased relatively MORE in obstructive (problem with airway breathing out)
FEV1/FVC decreased in obstructive, NOT in restrictive

150
Q

Clinical applications: PFT: normal to increased

A

restrictive lung disease
spondylitis
fibrosis

anything to restrict your chest cage
nothing wrong with your airway

151
Q

Clinical applications: PFT: decreased

A

asthma
chronic bronchitis
emphysema

152
Q

In emphysema, do you have problems with expansion or recoil?

A

recoil

153
Q

In emphysema, the reason your FEV1/FEV RATIO is low is bc

A

your recoil is not good so you dont push out your FEV1 but your FVC (where you have time) does not change very much and will not be as low as obstructive

154
Q

Blue bloater

A

blue, not dyspneic bc body got used to high CO2, polycythemia, edematous (cor pulmonae) bc PVR is high (severe hypoxemia

155
Q

Pink puffer

A

pink, dyspneic, mild hypoxemia, NO cor pulmonale, not edematous,

156
Q 
How does lung compliance change with aging?
pulm fibrosis?
emphysema?
normal lung?
presence of surfactant?
A 
goes up
down
up
normal
up
157
Q

What would not lead to hypoxemia?

A

polycythemia

Respiratory Physiology (1 decks)

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