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SF3 Exam 2 > SF3 Exam 2 Respiratory Mechanics > Flashcards

SF3 Exam 2 Respiratory Mechanics Flashcards

1
Q

Pleural space is filled with? It exerts what type of force?

A

Pleural fluid. Negative pressure making the lung stick to the chest wall.

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2
Q

Visceral Pleura innervation vs parietal pleura

A

Visceral insensitive to pain, react to stretch

Parietal pleura somatic afferent and intercostal nerves. Perceives pain

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3
Q

Which generations have no gas exchange?

What is this commonly called?

A

0-16

Dead space

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4
Q

What range of generations start to have alveoli?

Which ones are most heavily involved in gas exchange?

A

17-23

20-23

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5
Q

RV Residual Volume

A

Amount of air that you cannot get out of the lung

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6
Q

Cm H20 is used to refer to?

What is this at room air?

mmHg is used to refer to?

A

Hydrostatic pressure

0 cm H20

Gas partial pressures

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7
Q

Which bronchus is situated higher?

A

Right higher than left

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8
Q

Apnea?

A

Absence of spontaneous ventilation

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9
Q

Eupnea

A

Normal spontaneous breathing

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10
Q

Orthopnea

A

Dyspnea which occurs when lying flat, causing person to sleep propped up

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11
Q

How do the lungs stay inflated in your thorax?

A

They are placed in an area where the intraplueral space is negative, so air tends to inflate them since they have a 0 atmospheric pressure.

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12
Q

Elastic recoil of the chest is?

Elastic recoil of the lung?

A

Chest- Outwards

Lung- Inwards

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13
Q

Functional Residual Capacity (FRC)

A

Point where recoil forces (Inner recoil of lung matches outer recoil of chest wall)

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14
Q

What is the main contributor to lung recoil?

A

Surface tension

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15
Q

How does Surface tension play a role in the lungs?

A

When on the surface, there are unbalanced forces that pull molecules downward away from the side exposed to air.

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16
Q

Alveoli can be thought of as a circle of air surrounded by water. Explain the surface tension net effect on this

A

The molecules have angled effects on one another, with an overall vector of inwards towards the air. This is why the lung wants to collapse.

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17
Q

Explain how Laplace’s law would predict 2 alveoli to interact?

The first has r and the second is 2r Laplaces law p=2T/r

What occurs in an actual lung? Describe the relationship.

Revisit the original alveoli with this info.

A

1st- 2T/r

2nd- 2T/2r=T/r

  • SO 1>2

1 would empty into 2, causing a shunt through the lung

Surfactant exists in the lung. It lowers surface tension.

Surfactant is inversely proportional to Surface tension.

Area 1= 4pi(r)^2

Area 2= 4pi(2r)^2

2 is 4 times bigger than 1 (Each has the SAME surfactant) so

1=y/4pi(r)^2

2=y/16pi(r)^2

Surfactant is 4X in Unit 1. Is spread over less area. Since surfactant and Surface tension are inverse, The Surface tension of Unit 2 is 4 times greater.

ACTUAL lung happening.

1=2T/r

2=2(4T)/(2r)= 4T//r

  • 2>1
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18
Q

Who are the main players in inhalation?

A

Diaphragm.

External intercostal muscles lift the rib cage

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19
Q

What are the accessory muscles of inhalation?

When are they used?

A

Shoulder/neck muscles

Recruited in exercise, COPD and emphysema

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20
Q

What stance is commonly seen in COPD patients?

Why do they do this?

A

Tripod stance. Sits or stands leaning forward, supporting the upper body with hands on the knees.

This takes advantage of the accessory muscles.

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21
Q

What type of process is normal exhalation?

A

It is normally passive. The diaphragm is just relaxing back to normal.

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22
Q

When is the Ptm equal to the elastic recoil of the lung in inhalation? What happens throughout inhalation?

A

Right at the beginning and then again at the end. In the middle, transmural pressure becomes larger than recoil, so the lung expands.

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23
Q

What does Boyle’s law tell us about alveoli

A

Law is that volume is inverse to pressure, so as they fill with air, the pressure decreases in the pleural space.

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24
Q

Tension pneumothorax

A

More and more air accumulates with each breath

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25
Q

Non-tension pneumothorax

A

Air present in cavity, but not accumulating with each breath.

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26
Q

Atelectasis vs Pneumothorax

A

Atelectasis has NO air entering pleural space. The entire mediastinum shifts to the side of the collapse.

Pneumothorax the mediastinum shifts away from the collapse.

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27
Q

Specific Compliance

A

Normalize to body size of individual.

SC=Compliance/FRC

Where compliance = V/P

28
Q

What is used to measure compliance.?

A

Spirometry

29
Q

How is total compliance found? What is the relationship?

A

1/TC=1/lung comp+1/chest wall comp

They are in series, but add reciprocally. This is UNIQUE.

30
Q

What protein is deficient in emphysema?

A

Alpha1-antitrypsin

31
Q

What is regulated by alpha1-antitrypsin?

A

Elastase activity.

Without the antitrypsin, the lung tissue is destroyed

32
Q

What is the tissue destruction in emphysema called?

A

Alveolar simplification

33
Q

What effect does tissue destruction in emphysema have?

A

It makes the lung softer and more compliant.

34
Q

Centrilobular Emphysema is caused by?

What portion of the lung is most effected?

A

Most common. Long standing cigarette smoking.

Begins at respiratory bronchioles and spreads peripherally. Upper lung most effected

35
Q

Panacinar emphysema is caused by?

What part of the lung is mostly effected?

A

Destroys entire alveolus uniformly.

Lower lung most effected

Alpha1-antitrypsin deficiency Or Ritalin induced- crushed pill injected and struck in blood vessels of lungs

36
Q

Which way does the curve shift for emphysema?

Fibrosis?

Why?

A

Emphysema- shifts left due to increased compliance from softer tissue

Fibrosis- shifts to the right due to stiffer tissue

37
Q

What reasons would cause a decrease in compliance?

How does this effect the lung?

A

Fibrosis

Loss of surfactant

Removal of one lobe

Obesity

Pulmonary Vascular congestion (washes off surfactant)

This makes the lung stiffer and shift to the right.

38
Q

What reasons would cause an increase in compliance?

How does this effect the lung? What about the curve?

A

Emphysema and Age

Lung is softer

The curve shifts to the left

39
Q

Explain how compliance adds in the lungs and chest wall versus within lungs.

A

Chest wall and lungs add reciprocally

Lungs add straight together

40
Q

What does Poiseullie Equation tell us?

A

Laminar flow Resistance is sensitive to radius

(sensitive to radius to the 4th power)

41
Q

What are the airways arrangement?

Which type has the lower resistance? The highest?

A

They are arranged in parallel, so you add reciprocally for resistance.

Smaller airways have much lower resistance.

Larger airways have much higher resistance.

42
Q

How does the velocity in airways work (large v small)?

Also how does resistance work in these vessels (large v small)?

A

Large airways have high velocity and high resistance

Smaller airways have low velocity and low resistance

Ex) 4 lanes merging into 2 and cars going faster

43
Q

Explain passive exhalation

A

Relax diaphragm

Negative intrapleural pressure

Positive alveolar that gets less positive as it goes toward the mouth.

Negative intrapleural pressure holds open airway entire time.

44
Q

Explain Forced Exhalation. Where is this an issue?

What explains this?

A

You force an exhale, muscles push against the diaphragm

Pleural pressure becomes POSITIVE

Alveolar pressure is POSITIVE

The airway has a spot where outside pressure is greater than in it, so DYNAMIC COMPRESSION occurs.

Normally C cartilage keeps airway open but in emphysema this is a major issue.

45
Q

What explains why dynamic compression happens?

A

Bernoulli Effect- airflow is faster (less pressure) on top of wing

Glottis is closed.

Uniform P1 everywhere.

Open glottis, airflow is faster in the airway, making pressure lower there. When people forcefully exhale, they are increasing velocity even more in the airway, making a lower pressure there. This is more susceptible to dynamic collapse.

46
Q

What do alveoli tend to do in the lung?

When are they likely to not present this way?

A

Tether together to neighbors.

Emphysema causes a loss of tethering. If not connected, they can collapse easier.

47
Q

Tidal Volume

A

Volume inspired or expired with each breath

48
Q

Dead Space Volume

A

1st 17 gen NOT used in gas exchange (nose,pharynx, trachea)

49
Q

Residual Volume

A

Amount of air in lungs that can’t be exhaled/pushed out

50
Q

Total Lung capacity

A

Volume of air in lungs after a maximal inspiration effort

51
Q

Forced Vital Capacity (FVC)

A

Amount of air that can be exhaled quickly during a forced exhalation.

52
Q

How do you measure FRC in a normal person?

A person with emphysema?

A

Helium dilution technique

Body box plehysmography

53
Q

What influences FRC? (5 things)

A

Body position

  • Upright- increased FRC
  • Supine- decreased FRC (guts on diaphragm)

Age -Increase of compliance leads to more air in lung which means increased FRC

Obesity/Pregnancy -decrease FRC (push on diaphragm)

Lobe of Lung removed -decreased FRC (less volume)

Emphysema -Higher FRC due to air pockets in lungs (barrel chest)

54
Q

Functional Residual Capacity (FRC)

A

Volume of air in lung when chest wall and lung have equal recoil

55
Q

What are the obstructive diseases?

What are these characterized by?

A
  1. Emphysema
  2. Asthma
  3. Bronchitis
  4. Cystic Fibrosis
  5. COPD

High airway resistance

56
Q

What are the restrictive diseases?

What are these characterized by?

A
  1. Pulmonary Fibrosis
  2. Sarcoidosis Silicosis
  3. Asbestosis Wegner’s
  4. Granulomatosis

Stiff lung, high lung recoil

57
Q

What is FEV1? What does this correspond to?

A

The amount of air exhaled in 1 second of forced exhalation. This is typically >80% of FVC.

If this number is abnormally low, it is indicative of an obstructive pulmonary disease. This shows the person has a high airway resistance.

58
Q

How do we normalize FEV1 values? What do they indicate?

A

FEV/FVC

Lower value, Obstructive.

Higher value, Restrictive.

59
Q

How does the volume/flow graph change with emphysema?

A

The volume flow loop shifts to the left, which is toward larger volumes.

Flow rate is much smaller and has a curved inward line.

Obstructive

60
Q

How does a restrictive disease effect volume//flow loops?

A

The loop shifts to the right, a smaller volume bc of a stiffer lung.

61
Q

Compare obstructive vs Restrictive disease appearances on a flow volume graph. Give an example of each disease.

A

Obstructive have a curved inward slope

Restrictive diseases have a pointed appearance with a steep slope.

Obstructive- emphysema

Restrictive- Sarcoidosis

62
Q

What does a tumor of the lower trachea effect? (Variable intrathoracic)

A

It effects expiration.

The graph will have a peak point in the upper flow volume loop

63
Q

What does a fat deposit/ vocal chord paralysis effect? (Variable extrathoracic)

A

Inhalation.

The graph is flat on the bottom half of the. Inspiration portion.

64
Q

How does a fixed tumor or tracheal stenosis in a central airway effect flow volume loops? (Fixed intra or extrathoracic lesion)

A

It effects both inhalation and exhalation and causes them to be plateaued

65
Q

How is the methacholine test used?

A

You do 5 test intervals with increasing metacholine dosage. If the test drops to 20% lower than the original number during the intervals and below 8 mg/mL, the person has hyper reactive airways

66
Q

What should be similar in the methacholine test?

A

Baseline and control

SF3 Exam 2 (11 decks)

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