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BFCBP Respiratory Physiology > Respiratory Physiology II > Flashcards

Respiratory Physiology II Flashcards

1
Q

What are the two major inspiratory muscles/muscle groups?

A
  1. The diaphragm.

2. The external intercostal muscles.

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2
Q

What are the three accessory muscles/muscle groups of inspiration and when do they contract?

A
  1. Sternocleidomastoid.
  2. Scalenus.
  3. Pectoral.

These only contract during forceful inspiration.

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3
Q

What are the two muscle groups that contract during active expiration?

A
  1. Abdominal muscles.

2. Internal intercostal muscles.

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4
Q

What is tidal volume (TV) and its average value?

A

The volume of air which enters the lungs during normal inhalation at rest.

Its average value is 0.5 L.

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5
Q

What is inspiratory reserve volume (IRV) and its average value?

A

The additional volume of air that can be drawn into the lungs by determined effort after normal inspiration.

Its average value is 3.0 L.

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6
Q

What is expiratory reserve volume (ERV) and its average value?

A

The additional volume of air that can be expired from the lungs by determined effort after normal expiration.

Its average value is 1.0 L.

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7
Q

What is residual volume (RV) and its average value?

A

The volume of air still remaining in the lungs after the most forcible expiration possible.

Its average value is 1.2 L.

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8
Q

Are predicted normal lung volumes and capacities the same across the population?

A

No, they vary with age, height, male/female, etc.

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9
Q

What is inspiratory capacity (IC) and its average value?

A

The total volume of air that can be drawn into the lungs after normal expiration. (IC = IRV + TV).

Its average value is 3.5 L.

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10
Q

What is functional residual capacity (FRC) and its average value?

A

The volume of air present in the lungs after normal, passive expiration. (FRC = ERV + RV).

Its average value is 2.2 L.

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11
Q

What is vital capacity (VC) and its average value?

A

The volume of air that can be forcibly exhaled after a full inspiration. (VC = IRV + TV + ERV).

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12
Q

What is total lung capacity (TLC) and its average value?

A

The volume of air contained in the lungs at the end of a maximal inspiration, i.e., the maximal volume of air that the lungs can hold. (TLC = VC + RV).

Its average value is 5.7 L.

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13
Q

What two measurements cannot be obtained by spirometry?

A
  1. Residual volume (RV).
  2. As a result of this, total lung capacity (TLC).

Even though vital capacity (VC) can be obtained by spirometry, need RV to calculate TLC.

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14
Q

What happens to the residual volume when the elastic recoil of the lungs is lost?

A

It increases - this makes sense as the pre-inspiratory volume of the lungs will be greater.

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15
Q

What two dynamic lung volumes can be determined from a spirometry volume-time curve?

A
  1. FVC - forced vital capacity.
  2. FEV1 - forced expiratory volume, the volume of air which can be expelled in the first second of a maximal forced expiration after a full inspiration.
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16
Q

What are measurements for FVC and FEV1 used to calculate in clinical practice?

A

The FEV1/FVC ratio - this represents the proportion of the forced vital capacity which can be expelled in the first second.

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17
Q

What is the normal percentage value which the FEV1/FVC ratio exceeds in a healthy individual?

A

70%.

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18
Q

Determining dynamic lung volumes can be useful in the diagnosis of which two types of lung disease?

A
  1. Obstructive.

2. Restrictive.

19
Q

What is the typical pattern seen in spirometry when a patient has an obstructive lung disease?

A

Volume-time curve is much less steep initially compared to normal.

(It still reaches the same FVC as seen in a normal individual, however.)

20
Q

An FEV1/FVC ratio lower than which value tends to be indicative of obstructive lung disease?

A

70%.

21
Q

What is the typical pattern seen in spirometry when a patient has a restrictive lung disease?

A

Volume-time curve “squashed” compared to normal.

Does not reach the same FVC as seen in a normal individual.

22
Q

A low or normal FVC, low FEV1, and low FEV1/FVC% indicates the presence of which type(s) of lung disease?

A

Obstructive lung disease.

23
Q

A low FVC, low FEV1, and normal FEV1/FVC% indicates the presence of which type(s) of lung disease?

A

Restrictive lung disease.

24
Q

A low FVC, low FEV1, and low FEV1/FVC% indicates the presence which type(s) of lung disease?

A

A combination of both obstructive and restrictive lung diseases.

25
Q

What is the formula to calculate airway resistance?

A

F = (change in P)/R, where F = flow, P = pressure and R = resistance.

26
Q

What is the primary determinant of airway resistance?

A

The radius of the conducting airway.

27
Q

What does parasympathetic airway simulation cause?

A

Bronchoconstriction.

28
Q

What does sympathetic airway stimulation cause?

A

Bronchodilatation.

29
Q

Is expiration or inspiration more difficult in disease states which cause resistance to airflow? Why is this?

A

Expiration is more difficult for these patients.

During inspiration, airways are pulled open by the expanding thorax (fall in intrapleural pressure). However, during expiration, the chest recoils (rise in intrapleural pressure) and produces inward collapsing forces on the airways.

30
Q

What causes dynamic airway compression during active expiration?

A

Rising pleural pressure compresses the alveoli and the airway.

31
Q

Does dynamic airway compression cause problems in normal people?

A

No, as the resistance created increases the driving pressure between the alveolus and the airway.

32
Q

Why does dynamic airway compression cause problems in people with obstructive airway diseases?

A

Obstruction results in the driving pressure between the alveolus and airway to be lost over the obstructed segment.

This causes a fall in airway pressure downstream resulting in airway compression by the rising pleural pressure during active expiration.

33
Q

What can cause dynamic airway compression to be worse in patients with obstructive disease?

A

Decreased elastic recoil of the lungs (e.g. emphysema and COPD).

34
Q

What does peak flow rate assess?

A

Airway function.

35
Q

Describe how an estimate of peak flow rate is obtained with a peak flow meter.

A

The patient takes a short, sharp blow into the peak flow meter and the best of three attempts is taken.

36
Q

What is pulmonary compliance?

A

A measure of the effort that has to go into stretching or distending the lungs.

37
Q

What is the pulmonary compliance from a technical point of view?

A

The volume change per unit of pressure change across the lungs.

38
Q

What does reduced compliance mean in terms of the work required when breathing?

A

More work is required to produce a given degree of inflation.

39
Q

What are some factors that decrease pulmonary compliance?

A

Pulmonary fibrosis, pulmonary oedema, pneumonia, absence of surfactant.

40
Q

What symptom does decreased pulmonary compliance typically cause?

A

Shortness of breath, especially on exertion.

41
Q

What pattern of lung volumes may decreased pulmonary compliance cause on spirometry?

A

A restrictive pattern.

42
Q

What can cause increased pulmonary compliance and what is this a result of?

A

Emphysema and increasing age.

Due to loss of elastic recoil of the lungs.

43
Q

What is hyperinflation of the lungs?

A

Difficulty in expelling air from the lungs, resulting in increased functional residual volume.

44
Q

What four situations result in the work of breathing becoming increased?

A
  1. Decreased pulmonary compliance.
  2. Increased airway resistance.
  3. Decreased elastic recoil.
  4. When a need for increased ventilation arises.

BFCBP Respiratory Physiology (6 decks)

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