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Physiology > Respiratory, Topnotch + CDB > Flashcards

Respiratory, Topnotch + CDB Flashcards

1
Q

End of conducting zone

A

Terminal bronchioles

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2
Q

How many generations of airways in the respiratory system

A

23

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3
Q

How many alveoli are in the respiratory system

A

300 million

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4
Q

Effect of SY nervous system on airways and via what receptor

A

Bronchodilation via b2

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5
Q

Effect of PSY nervous system on airways and via what receptor

A

Bronchoconstriction via M

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6
Q

% Type I pneumocyte in lungs

A

97%

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7
Q

Histology of type I pneumocytes

A

Squamous

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8
Q

Histology of type II pneumocytes

A

Cuboidal

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9
Q

Purpose of Type I pneumocytes

A

Gas exchange

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10
Q

Purpose of Type II pneumocytes (3)

A

1) Surfactant production
2) Turn into type I when needed
3) Proliferate during lung damage

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11
Q

Special cells in the lungs in patients with CHF

A

Alveolar macrophages that have become siderophages/hemosiderin-laden macrophages

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12
Q

Disease entity where goblet cells and submucous glands undergo hypertrophy and hyperplasia

A

COPD

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13
Q

Cells that may play a role in epithelial regeneration, secrete component of surfactant, degrade toxins, and act as reserve cells

A

Clara cells

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14
Q

Histology of Clara cells

A

Non-ciliated columnar

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15
Q

Where pulmonary veins return

A

Left atrium

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16
Q

Bronchial circulation receives ___% of cardiac output

A

1-2

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17
Q

Where bronchial circulation drains (2)

A

1) 1/3 R atrium via bronchial veins

2) 2/3 L atrium via pulmonary veins

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18
Q

Tidal volume in normal adult

A

500mL

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19
Q

IRV

A

3000mL

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20
Q

ERV

A

1200mL

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21
Q

RV

A

1200mL

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22
Q

Total volume of lung that does not participate in gas exchange

A

Physiologic dead space

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23
Q

Formula of physiologic dead space

A

Anatomic dead space + alveolar dead space

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24
Q

Air in conducting zone corresponds to

A

Anatomic dead space

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25
Q

Increase or decrease: Anatomic dead space during mechanical ventilation

A

Increase

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26
Q

Normal volume in conducting zone

A

150mL

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27
Q

Normal volume in alveolar dead space

A

0mL

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28
Q

Volume of air moved into and out of the lungs per unit time

A

Ventilation rate

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29
Q

Total rate of air movement in/out of lungs

A

Minute ventilation

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30
Q

Minute ventilation corrected for physiologic dead space

A

Alveolar ventilation

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31
Q

Formula for minute ventilation

A

Tidal volume x breaths per minutes

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32
Q

Formula for alveolar ventilation

A

(Tidal volume - Physiologic dead space) x breaths/min

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33
Q

Increased vs decreased: FEV1 and FVC in obstructive and restrictive lung diseases

A

Decreased

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34
Q

FEV1/FVC in normal healthy person

A

70%

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35
Q

FEV1/FVC ratio in restrictive disease

A

Increased or normal

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36
Q

FEV1/FVC ratio in obstructive disease

A

Decreased

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37
Q

Muscle involved in normal inspiration

A

Diaphragm

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38
Q

Muscle involved in normal expiration

A

None; passive process

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39
Q

Change in volume required for a fractional change of pulmonary pressure

A

Compliance

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40
Q

Pressure required for a fractional change of lung volume

A

Elastance

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41
Q

Pressure-volume work performed in moving air into and out of the lungs

A

Work of breathing

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42
Q

Property of matter that makes it resist deformation

A

Elastance

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43
Q

3 primary sources of resistance encountered during inspiration

A

1) Airway resistance
2) Compliance resistance
3) Tissue resistance

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44
Q

Airway resistance accounts for __% of work of breathing

A

20

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45
Q

Work that must be performed to overcome the intrinsic elastic recoil of the lungs

A

Compliance resistance/work

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46
Q

Compliance resistance accounts for __% of work of breathing

A

75

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47
Q

Law that implies that small changes in airway diameter have dramatic impact on airflow resistance because resistance is inversely related to the r^4

A

Poiseuille’s Law

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48
Q

Large vs small airways: Arranged in series, resistance additive

A

Large

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49
Q

Large vs small airways: Arranged in parallel, resistance added reciprocally

A

Small

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50
Q

Forced Inspiration vs Expiration: External intercostals

A

Inspiration

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51
Q

Forced Inspiration vs Expiration: Internal intercostals

A

Expiration

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52
Q

FEV1

A

Maximum volume of air that can be exhaled in 1 second after maximal inspiration

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53
Q

Increased vs decreased: FRC in emphysema

A

Increased

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54
Q

Increased vs decreased: FRC in pulmonary fibrosis

A

Decreased

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55
Q

Force exerted by water in an air-fluid interface that minimizes surface area

A

Surface tension

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56
Q

Emphysema: Destruction of elastic tissue is mediated by

A

Neutrophil-derived elastases

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57
Q

Examples of restrictive lung disease (2)

A

1) Silicosis

2) Asbestosis

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58
Q

Increased tendency of alveoli to collapse on expiration as radius decreases

A

Law of Laplace

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59
Q

Predisposing factors for atelectasis in preterm babies

A

1) Small alveolar radius (50 um) compared to adult (100 um)

2) Lack of mature surfactant

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60
Q

Composition of surfactants

A

1) Lipids (90%)

2) Proteins (10%)

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61
Q

Active component of surfactant

A

DPPC

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62
Q

Mechanism for DPPC in reducing surface tension

A

Amphipathic nature

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63
Q

Start of surfactant production

A

24th week AOG

64
Q

Maturation of surfactant

A

35th week AOG

65
Q

L:S ratio that indicates lung maturation

A

> 2.0

66
Q

Transpulmonary pressure =

A

Alveolar pressure - Intrapleural pressure

67
Q

Positive vs Negative: Transpulmonary pressure in expanded lungs

A

Positive

68
Q

Positive vs Negative: Transpulmonary pressure in collapsed lungs

A

Negative

69
Q

Ability of respiratory membrane to exchange gas

A

Diffusion capacity

70
Q

Diffusion capacity of O2 at rest

A

21 mL/min/mmHg

71
Q

Diffusion capacity of O2 at maximal exercise

A

65 mL/min/mmHg

72
Q

Diffusion capacity for CO2 at rest

A

400-450 mL/min/mmHg

73
Q

Diffusion capacity of CO2 at maximal exercise

A

1200-1300 mL/min/mmHg

74
Q

Forms of gas in solutions

A

1) Dissolved
2) Bound
3) Chemically modified

75
Q

Only form of gas that contributes to partial pressure

A

Dissolved gas

76
Q

Difference between PAO2 and PaO2

A

A-a gradient

77
Q

A vs a: Higher O2

A

Alveolar (A)

78
Q

Why A is slightly higher than a

A

Due to blood that bypasses the alveoli (physiologic shunt)

79
Q

2 types of alveolar-blood gas exchange

A

1) Perfusion-limited

2) Diffusion-limited

80
Q

Characteristics of perfusion-limited gas exchange (2)

A

1) Gas equilibrates with the pulmonary capillary near the start of the pulmonary capillary
2) Diffusion increased only by increasing blood flow

81
Q

Characteristic of diffusion-limited gas exchange

A

Gas does not equilibrate

82
Q

O2 transport at rest

A

Perfusion-limited

83
Q

O2 transport during exercise and disease states (emphysema, fibrosis)

A

Diffusion-limited

84
Q

Percentage of dissolved O2

A

2%

85
Q

Percentage of O2 bound to Hgb

A

98%

86
Q

Hgb with iron in the ferric form hence does not bind with O2

A

Methemoglobin

87
Q

Which hgb chain is abnormal in sickle cell anemia

A

Beta chain

88
Q

Hgb increases the O2-carrying capacity of blood ___-fold

A

70

89
Q

Shape of O2-Hgb dissociation curve

A

Sigmoidal

90
Q

% saturated: PO2 of 25 mmHg

A

50% (P50)

91
Q

% saturated: PO2 of 40 mmHg

A

75%

92
Q

% saturated: PO2 of 100 mmHg

A

Almost 100%

93
Q

Characteristic of O2-Hgb dissociation curve where binding of first O2 molecule increases affinity for 2nd O2 molecule and so forth

A

Positive cooperativity

94
Q

Causes of shift to the left in the O2-Hgb dissociation curve

A

1) CO

2) HbF

95
Q

90% (CDB: 70%) CO2 in blood is in the form of

A

HCO3-

96
Q

5% (CDB: 7%) CO2 in blood is in the form of

A

Dissolved CO2

97
Q

3% (CDB: 23%) CO2 in blood is in the form of

A

CarbaminoHgb

98
Q

Cl-HCO3 exchange in the RBC

A

Chloride shift using Band 3 protein

99
Q

O2 affecting affinity of CO2/H to Hgb INVERSELY

A

Haldane effect

100
Q

CO2/H affecting affinity of O2 to Hgb INVERSELY

A

Bohr effect

101
Q

Phenomenon normally encountered after a meal wherein there is a temporary increase in pH

A

Alkaline tide

102
Q

Substances that cause bronchoconstriction

A

Leukotrienes

103
Q

Effect of hypoxia (low pAO2) on pulmonary arterioles

A

Vasoconstriction

104
Q

Zone of the lung: Local alveolar capillary pressure is less than alveolar air pressure THROUGHOUT the cycle

A

Zone 1

105
Q

Zone of the lung: Local alveolar capillary systolic pressure > alveolar air pressure during systole but less than that during diastole

A

Zone 2

106
Q

Zone of the lung: Local alveolar capillary pressure > alveolar air pressure THROUGHOUT the cycle

A

Zone 3

107
Q

Lung zone seen with severe hemorrhage and positive-pressure ventilation

A

Zone 1

108
Q

Normal V/Q ratio

A

0.8

109
Q

V/Q in ventilated area of the lungs with (-) perfusion

A

Infinity

110
Q

Disease entity where V/Q = infinity

A

Pulmonary embolism

111
Q

V/Q in lungs with perfusion but no ventilation

A

0

112
Q

Disease entity where V/Q = 0

A

Shunt/airway obstruction

113
Q

Conversion of CO2 to carbonic acid as it reacts with water is catalyzed by what enzyme

A

Carbonic anhydrase

114
Q

Structure that is defective in congenital diaphragmatic hernia

A

Pleuroperitoneal membrane

115
Q

Anterior diaphragmatic hernia

A

Morgagni

116
Q

Posterior diaphragmatic hernia

A

Bochdaleck

117
Q

Accessory inspiratory muscles (3)

A

1) SCM
2) Scaleni
3) Serratus anterior

118
Q

Accessory expiratory muscles

A

1) Internal intercostals

2) Abdominal recti

119
Q

Pleural pressure at the beginning of inspiration

A

-5 cm H2O

120
Q

Pleural pressure at the end of inspiration

A

-7.5 cm H2O

121
Q

Flail chest (2)

A

1) 2 or more contiguous ribs

2) 2 or more fracture points

122
Q

Driving force for inspiration

A

Negative intrapleural pressure created by diaphragm and external intercostals

123
Q

Driving force for expiration

A

1) Increase in intrapleural pressure

2) Alveolar recoil

124
Q

Alveolar ventilation at rest

A

4L/min

125
Q

Mechanisms of maintaining V/Q matching (2)

A

1) Hypoxia-induced vasoconstriction

2) Changes during exercise (recruitment and distention)

126
Q

Blood that bypasses the lungs or for another reason does not participate in gas exchange

A

Shunt

127
Q

Anatomic shunt of the respiratory system

A

Blood bypasses lungs

128
Q

Examples of anatomic shunt of the respiratory system (2)

A

1) Fetal blood flow

2) Intracardiac shunting

129
Q

Physiologic shunt of the respiratory system

A

Blood flows to unventilated portions of lungs

130
Q

Examples of physiologic shunt of the respiratory system (3)

A

1) Bronchial circulation
2) Pneumonia
3) Pulmonary edema

131
Q

Causes the arterial PO2 to decrease from 104 to 95mmHg

A

Bronchial circulation

132
Q

Regulators of respiration (5)

A

1) Cerebral cortex
2) Midbrain and pons
3) Central and peripheral chemoreceptors
4) Mechanoreceptors
5) Respiratory muscles

133
Q

Central controller of breathing that can override the autonomic brainstem centers

A

Cerebral cortex

134
Q

Creates the basic respiratory rhythm

A

Medulla

135
Q

Modifies the basic respiratory rhythm

A

Pons

136
Q

Inspiratory center

A

DRG

137
Q

Overdrive mechanism during exercise

A

VRG

138
Q

Prolongs inspiratory phase > decreases RR

A

Apneustic

139
Q

Limits time for inspiration > increases RR

A

Pneumotaxic phase

140
Q

Central chemoreceptors for respiration are found in the

A

Ventral medulla

141
Q

Regulators of respiration: Ventral medulla responds directly to

A

CSF H+

142
Q

Regulators of respiration: Response of ventral medulla to acidosis

A

Increases RR

143
Q

Where peripheral chemoreceptors of respiration are found

A

Carotid and aortic bodies

144
Q

Peripheral chemoreceptors of respiration respond mainly to

A

PaO2

145
Q

Response of peripheral chemoreceptors of respiration to decrease on PaO2

A

Increases RR

146
Q

Mechanoreceptors of respiration

A

1) Lung stretch receptors
2) Joint and muscle receptors
3) Irritant receptors
4) J receptors

147
Q

Stimulus to lung stretch receptors

A

Lung distension

148
Q

Response of lung stretch receptors

A

Hering-Breuer reflex

149
Q

Hering-Breuer reflex

A

Decreases RR by prolonging expiratory time

150
Q

Regulators of respiration: Stimulus to joint and muscle receptors

A

Limb movement

151
Q

Regulators of respiration: Response of joint and muscle receptors

A

Increases RR during exercise

152
Q

Stimulus to irritant receptors of respiration

A

Noxious chemicals

153
Q

Regulators of respiration: Response of irritant receptors (2)

A

1) Bronchoconstriction

2) Increases RR

154
Q

Responsible for dyspnea in left-sided heart failure

A

J receptors

155
Q

Stimulus to J receptors

A

Pulmonary capillary engorgement

156
Q

Response of J receptors

A

Rapid shallow breathing

157
Q

Only gas in inspired air found exclusively in dissolved form

A

Nitrogen

Physiology (15 decks)

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