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AS - N932 Advanced Pathology > Respiratory Physiology > Flashcards

Respiratory Physiology Flashcards

1
Q

Parietal Pleura

A

Membrane that lines the inner chest wall surface

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2
Q

Visceral Pleura

A

Membrane that lines the outer lung surface

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3
Q

Pleural Space

A

Potential space

Contains mucoid/serous fluid that allows the parietal & visceral pleura to slide easily ↓friction

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4
Q

Inspiratory Muscles

A

Diaphragm 1° ventilation muscle
External intercostals
Accessory muscles - sternocleidomastoid, trapezius, & scalene

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5
Q

Expiration

A

PASSIVE

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6
Q

Forced Expiration

A

Internal intercostals

Accessory muscles - internal/external obliques, transversus abdominus, & rectus abdominus

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7
Q

Alveolar Interdependence

A

Alveoli connected

Negative pressure gradient transfers from outer alveoli to innermost

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8
Q

Radial Traction

A

Outside airways are tethered to alveolar wall

↑Pel ↑radial traction ↑airway diameter ↓resistance

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9
Q

LaPlace

A

P = (surface tension x 2) / radius

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10
Q

Air-Liquid Interface

A

H2O molecules have mutual attraction

Surface tension b/w air & water

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11
Q

Surfactant

A 
Amphipathic molecule (detergent)
Polar & non-polar
↓Pel ↓WOB
Prevents alveoli from emptying small → large
Atelectasis ↓gas exchange
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12
Q

Deadspace

A

= VT [(PaCO2 - PeCO2) / PaCO2]
Over ventilation and/or under perfusion
Impaired gas exchange → V/Q mismatch ↑V/Q
Causes: PE, hypovolemia, cardiac arrest, shock, ↓pulmonary blood flow

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13
Q

Shunt

A

Ø alveolar ventilation d/t blockade or edema
Ø gas exchange → V/Q mismatch ↓V/Q
Absolute shunt V/Q = 0
Hypoxia unresponsive to supplemental oxygen

Causes: ETT mainstem, mucus plug, atelectasis, pneumonia, pulmonary edema, anything collapse alveoli

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14
Q

Oxyhemoglobin Dissociation Curve

Right Shift

A

↑CO2 hypercapnia
↓pH
↑H+ ion
↑temperature
↑BPG (2,3 diphosphoglycerate) ↑metabolism
Acidotic - oxygen more easily dissociates from hemoglobin
↓affinity

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15
Q

Oxyhemoglobin Dissociation Curve

Left Shift

A 
↓CO2 hypocapnia
↑pH alkalosis
↓H+ ion
↓temperature
↓BPG
Alkalotic - more difficult to unload oxygen
↑affinity
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16
Q

Fick’s Law

A

Gas diffusion across the alveolar-capillary membrane

= (area x diffusion coefficient x ΔP) / thickness

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17
Q

Air Components

A

79% nitrogen
21% oxygen
1% trace gases

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18
Q

Atmospheric Pressure

A

760mmHg

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19
Q

Upper Airway

A

Nose, mouth, pharynx, larynx, trachea

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20
Q

Nose

A

Filtration, smell, & air humidification

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21
Q

Larynx

A

Epiglottis, thyroid, & cricoid

Paired - arytenoid, corniculate, cuneiform

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22
Q

Motor Innervation

A

RLN motor all EXCEPT cricothyroid muscle

SLN external - cricothyroid muscle

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23
Q

Sensory Innervation

A

SLN internal - above & vocal cords

RLN - below the vocal cords

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24
Q

Posterior Cricoarytenoid

A

Please come apart

Vocal cord ABduction

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25
Q

Lateral Cricoarytenoid

A

Let’s close airway

Vocal cord ADduction

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26
Q

Cricothyroid

A

Cords tense

Vocal cord tension = laryngospasm

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27
Q

Thyroarytenoid

A

They relax

Vocal cord relaxation

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28
Q

Trachea

A

Incomplete cartilage rings - open posteriorly to prevent tracheal collapse
Transports gases b/w atmosphere & lung parenchyma
Begins at C6 (cricoid cartilage inferior border) & extends to carina
10-15cm
Cricoid = only complete ring
Bifurcates to R/L mainstem bronchus at T5

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29
Q

R Main Bronchus

A

T5
Shorter, wider, & more vertical
25-30° angle
R mainstem intubation

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30
Q

L Main Bronchus

A

T5

45° angle

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31
Q

R Lung

A

55% TLC

3 lobes

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32
Q

L Lung

A

45%

2 lobes

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33
Q

Diaphragm Innervation

A

C2-5

Phrenic nerve

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34
Q

Pneumocytes

A

Type 1 structural
Type 2 surfactant producing
Type 3 macrophages (alveolar)

35
Q

Conducting Zone

A

NO gas exchange (anatomic dead-space)
Nose/mouth → terminal bronchioles
Pseudostratified ciliated epithelium transitions → ciliated columnar epithelium → cuboidal epithelium (terminal bronchioles) mucus-secreting goblet cells also present
Blood supply from thyroid, bronchial, & internal thoracic arteries (systemic circulation)
150mL
1/3 VT
2mL/kg IBW

36
Q

Respiratory Zone

A

Gas exchange (diffusion) 350mL/500mL
Respiratory bronchioles, alveolar ducts, alveolar sacs, & alveoli
Cuboidal cells transitions → squamous epithelium
Blood supply from pulmonary circulation
Diameter 0.5mm & smaller

37
Q

Average Adult CARINA

A

Front incisors to larynx = 13cm
Larynx to carina = 13cm
ETT ideal location 2cm above the carina

38
Q

Transpulmonary Pressure

A

Difference b/w intrapleural & intra-alveolar pressures

*Determines lung size

39
Q

Neuronal Control

A

Brainstem - medulla & pons

40
Q

Medulla Control

A

Medulla control = DRG
Stimulates inspiration
“Pacemaker”
VRG helps w/ forced inspiration/expiration

41
Q

Pons Control

A

Modifies medulla output
Pneumotaxic center located high in the pons ↓VT
Apneustic center located lower in the pons ↑VT
- Output limited by baroreflex input from the lung & input from the pneumotaxic center

42
Q

Humoral Control

A

Central chemoreceptors response to hydrogen ion levels

Peripheral chemoreceptors respond to CO2, pH, & hypoxemia

43
Q

Normal Stimulus to Breathe

A

Hypercapnia

44
Q

Vagus

A

Cranial nerve X

Carries aortic arch & lung stretch signal to the DRG

45
Q

Glossopharyngeal

A

Cranial nerve IX

Carries the carotid body signals to the DRG

46
Q

Autonomic Control

PARASYMPATHETIC

A

Vagus
Mucus secretion, ↑vascular permeability, vasodilation, & bronchospasm
M3 receptor activation → bronchoconstriction

47
Q

Autonomic Control

SYMPATHETIC

A

Inhibit mediator release from mast cells
↑mucociliary clearance
β2 exogenous activation → bronchodilation

48
Q

FRC

A

Functional residual capacity
Point where lung elastic recoil = chest wall elastic recoil
Equilibrium point
Impacted by positioning, muscle relaxation, & insufflation

49
Q

Normal Respiratory Quotient

A

0.8
200/250
CO2 diffuse 200mL from the pulmonary capillary blood into the alveoli
O2 diffuse 250mL from the alveoli into the pulmonary capillary blood

50
Q

Compliance

A

Volume / Pressure

51
Q

Static Compliance

A

= VT / (Pplat - PEEP)
Normal 60-100mL/cmH2O
Lung & chest wall compliance w/ NO air movement

↓static compliance
Fibrosis, obesity, edema, vascular engorgement, ARDS, external compression, & atelectasis

Set an inspiratory pause to measure Pplat (only available in volume control)

52
Q

Dynamic Compliance

A

= VT / (peak pressure - PEEP)
Normal 50-100mL/cmH2O
Lung & chest wall compliance DURING a breath

↓dynamic compliance
Bronchospasm, tube kinking, mucous plug, external pressure, ↑RR, anything ↑airway resistance

53
Q

Surface Tension

A

SURFACTANT = 2/3

54
Q

Laminar Flow

A

Small airways ↓resistance

Reynold’s number <2,000

55
Q

Turbulent Flow

A

Large airways
Reynold’s number >4,000
Medium-sized bronchi = highest airway resistance

56
Q

Reynold’s Number

A

Indicates laminar or turbulent flow

2,000-4,000 considered transitional flow

57
Q

Poiseuille’s Law

A

= [(π ∙ ∆P ∙ r^(4 )] / (8 η l)

58
Q

West Zones

A

1 alveolar > arterial > venous pressure V/Q > 1
2 arterial > alveolar > venous pressure V/Q = 1
3 arterial > venous pressure > alveolar V/Q = 0.8
4 arterial > interstitial > venous pressure > alveolar V/Q < 1

59
Q

Closing Volume

A

Volume above residual when small airways close

60
Q

Closing Capacity

A

Absolute gas volume in the lung when small airways close
Factors that ↑closing capacity
- COPD, obesity, supine position, pregnancy, CHF, aging

Closing volume > FRC
Airway closure during normal tidal breathing → poorly or unventilated alveoli & intrapulmonary shunting

61
Q

Haldane Effect

A

Blood oxygenation displaces CO2 from hemoglobin
Ability to carry CO2 in different oxygen environments
Occurs at alveolar-capillary membrane

62
Q

Bohr Effect

A

Hemoglobin O2 affinity inversely proportional to CO2 levels
Acidic environment causes R shift
Occurs at the tissue level ↑CO2

63
Q

P50

A

PaO2 26-28mmHg

50% Hgb saturated

64
Q

SpO2:PaO2

A

90: 60
70: 40
60: 30

65
Q

DLCO

A

Tests lungs capacity to diffuse carbon monoxide
Normal >75%
Mild 60-75%
Moderate 40-60%
Severe <40%
Intrinsic lung issue - tissue damage
Breathe in & hold 10 sec then exhale fully

66
Q

CO2 Transportation

A
  1. Dissolved
  2. Chemically combined w/ amino acid proteins (bound to Hgb)
  3. Bicarbonate ions 80-90%

*Carbonic anhydrase assists reaction

67
Q

Hypoxic Hypoxia

A 
Issue w/in lungs
↓FiO2
Alveolar hypoventilation
V/Q mismatch
R → L shunt
***Supplemental FiO2***
Examples: COPD, overdose, high altitude, fibrosis, atelectasis, pulmonary embolism, congenital heart disease
68
Q

Circulatory Hypoxia

A

↓CO
Severe heart failure, dehydration, sepsis, SIRS
Treat underlying problem

69
Q

Hemic Hypoxia

A

↓hemoglobin content and/or function
Anemia, carboxyhemoglobin, methemoglobinemia
Treat underlying cause

70
Q

Demand/Histoxic Hypoxia

A

↑O2 consumption or inability to utilize O2
Fever, seizures, cyanide toxicity
Supplemental FiO2

71
Q

HPV

A

Hypoxic pulmonary vasoconstriction
↑PCO2 (acidosis) → vasoconstriction
↓PCO2 → vasodilation
Vasoconstriction in response to low regional PAO2
Diverts blood away from hypoxic → ventilated & oxygenated areas
Aims to optimize & correct V/Q mismatch

72
Q

Anatomical Deadspace

A

Air present in the airway that never reaches the alveoli

Unable to participate in gas exchange

73
Q

Alveolar Deadspace

A

Air w/in non-functional alveoli (disease or abnormal blood flow)
Unable to participate in gas exchange

74
Q

Physiological Deadspace

A

= anatomical + alveolar deadspace

75
Q

Upper Respiratory Infection

A 
↑WBCs
Inflamed & reddened mucosa
Mucopurulent nasal secretions
Congestion or rales
> 37°C
Tonsillitis
Viral oropharynx ulcer
Fatigue
Laryngitis
Sore throat
76
Q

Allergies

A 
HISTAMINE MEDIATED
Sneezing
Ash or boggy mucosa
Itchy/running nose
Conjunctivitis
Wheezing
Hives
Swollen lips, tongue, eyes, or face
Dry, red, & cracked skin
77
Q

PAO2

A

(PB - PH2O) x FiO2 - (PaCO2/0.8)

78
Q

A - a

A

PAO2 - PaO2

Normal 5-15mmHg

79
Q

a/A Ratio

A

PaO2/PAO2

Normal >75%

80
Q

Oxygen Content

A

CaO2 = (Hgb x 1.34 x SaO2) + (PaO2 x 0.003)

Normal 20.4mL per 100mL blood

81
Q

Oxygen Delivery

A

DO2 = CO x CaO2

82
Q

PaCO2

A

VCO2/VA

Total CO2 production / alveolar ventilation

83
Q

PaO2/FiO2

A 
P:F ratio
PaO2/FiO2
Normal 400
<300 mild ARDS
<200 moderate
<100 severe

AS - N932 Advanced Pathology (8 decks)

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