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Unit 2: Pulmonary Physiology Flashcards

1
Q

Anatomical dead space is a reflection of the size of the conducting airways. What are some things that could affect the size of the airwyas?

A
  • Radius: emphazema, smoking, mucus
  • Length: height of person
  • Minute-to-minute ventilaiton: tube on ventilator
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1
Q

What does a Ventilation/Perfusion scan assess?

A
  • Ventilation
  • Perfusion
  • Possible diagnoses
    • Ventilated (V) but not perfused (Q): pulmonary emboli *picture*
    • Q but not V: airway blocking or narrowing
    • Neither V nor Q: COPD or pneumonia
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1
Q

What are the two types of sleep apnea?

A
  1. Central Sleep Apnea
  2. Obstructive Sleep Apnea
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2
Q

In pulmonary perfusion, what is zone 2?

A
  • Intermediate zone
    • received intermittent blood flow - based on difference between arterial and alveolar pressures
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3
Q

What 3 factors can affect normal airway distribution?

A
  1. Airway obstruction
  2. Abnormal lung or chest wall compliance
  3. Respiratory muscle weakness
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3
Q

How would an increase in right ventricular stroke volume affect pulmonary artery pressure?

A

Results in greater pulmonary artery pressure and will cause zone 3 to extend farther up each lung (more gravity dependent = needs more blood)

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3
Q

What is Central Sleep Apnea?

A
  • Failure of respiratory centers
  • Can be result of:
    • Encephalitis
    • Brainstem infarction
    • Bulbar poliomyelitis
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4
Q

What are the respiratory control mechanisms during disease like diabetes?

A

ketoacidosis leads to dec pH → fires off peripheral chemoreceptors → inc ventilation and blowing off excess acid

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5
Q

What is elastic recoil in the lungs?

A

The ability of the lungs to return to their original shape after stretch.

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5
Q

What breaks up surface tension in the lungs?

A

Surfactant

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5
Q

What does the Apneustic Center do?

<em>Ex Phys Notes</em>

A
  • Works opposite the pneumotaxic center - prevents inspiratory neurons from switching off.
  • Normally inhibited by pneumotaxic center
  • NO role in normal respiration

**Absence of inhibition, apneustic center produced prolonged inspirations followed by short expiratory gasping (head injuries)**

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6
Q

What is Flow of Air dependent on?

A

Flow of air is related to pressure gradient and to the resistance of the airways.

Q (flow of air) = _/_ P/R (change in pressure over resistance)

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7
Q

Obstructive Sleep Apnea is sometimes referred to as __________ Syndrome.

A

Pickwickian

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8
Q

What is Kussmal’s breathing seen as an attempt to compensate for?

A

Metabolic acidosis (ex: diabetic ketoacidosis)

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9
Q

How would an increase in pulmonary vascular resistance affect perfusion?

A

Increase in resistance would decrease perfusion

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10
Q

Does anatomical dead space participate in gas exchange?

A

No

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11
Q

What are the two distinct respiratory groups (cluster of cells) located in the respiratory center?

<em>Ex Phys Notes</em>

A
  • Dorsal Respiratory Group (DRG) or Nucleus Tractus Solitarius (NTS)
  • Ventral Respiratory Group (VRG) or Nucleus Ambiguous
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11
Q

What is Hypoventilation?

What does its breathing pattern look like?

A

Shallow respirations (often irregular)

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12
Q

What is respiratory distress syndrome (RDS)?

A
  • Occurs in premies before 26-28 weeks
  • Born before surfactant is produced and breathing is difficult
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12
Q

What patient populations experience Cheyne-Stokes breathing?

A

Severe cardiac failure

Head injuy

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13
Q

What is the concern with descreasing tidal volume while increasing respiratory rate?

A

work of breathing (WOB) decreases tidal volume (TV) - patient cannot get good air down to alveolie because it is all in dead space

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14
Q

What produces surfactant in the lungs?

A

Type II alveolar cells

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14
Q

What is Eupnea?

How many breaths/min?

What does its breathing pattern look like?

A

Normal breathing rate and rhythm

12-20 breaths/min

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15
Q

Where is the Apneustic Center located?

<em>Ex Phys Notes</em>

A

Lower part of the pons

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17
Breathing at **low** volumes has what affect on air distribution in lungs?
Closes airways in the dependent portions and prevents distribution of air.
18
Where are the Peripheral Chemoreceptors located? *Ex Phys Notes*
The aortic and carotid bodies
19
What is physiological dead space?
Anatomical dead space + any other areas that don't exchange gases (aveolar dead space)
20
What is anatomical dead space?
Portion of tidal volume that is contained in the conducting airways (nose, mouth, pharynx, larynx, trachea, bronchi, and bronchioles)
21
What does the Pneumotaxic Center do? *Ex Phys Notes*
* Influences the rate or frequency of breathing * Inc firing: dec length of inspiration & inc respiratory rate * Dec firing: inc length of inspiration & dec respiratoy rate * Normal respiration happens in **absence** of pneumotaxic input
22
What is **Kussmaul's** breathing? What does its breathing pattern look like?
Deeper and faster respirations
24
What is lung compliance?
The ease with which lungs are inflated during inspiration.
25
Air will go where gravity pulls it. If you are supine, where will air sit in the lungs?
The posterior lung
26
How much physiological dead space is there compared to anatomical dead space?
* Should be equal * Accounts for about 30% of tidal volume
26
What is the Hering-Breuer Reflex?
Stimulated when tidal volume reaches ~1.5 L (normal is .5 L) - signals vagus nerve → DRG shuts off inspiration \*Prevents excessive lung expantion\*
27
What are the functions of the DRG (or NTS)? *Ex Phys Notes*
* Output goes to diaphragm and external intercostal muscles * Slow increase (2 seconds) * Expiration due to absence of stimulus (3 seconds)
29
Where is blood flow the greatest in the lungs?
About 6 times greater at the bases than at the apices
30
What is **Bradypnea**? How many breaths/min? What does its breathing pattern look like?
Decreased rate with normal rhythm \< 12 breaths/min
31
What four things make up the efferent neural input in the respiratory center? *Ex Phys Notes*
1. Cortex 2. Limbic System 3. Pneumotaxic Center 4. Apneustic Center
32
What do central chemoreceptors respond to? *Ex Phys Notes*
Changes in hydrogen Hydrogen does not pass through the blood brain barrier, so change in ventilation is an indirect response to an increase in CO2 (CO2 can pass through the blood brain barrier)
33
What is the idiopathic [unknown cause] form of central sleep apnea referred to? What does it result in?
* Ondine'e curse (story told by Jean in class) * Results in *conscious* effort to control ventilation
35
In pulmonary perfusion, what is zone 1?
* Least gravity dependent * received basically no blood flow
36
What happens to our respiratory control during Rapid Eye Movement (REM) sleep?
Muscle activity is reduced - including larynx and pharynx
38
What system causes bronchodilation?
Autonomic Nervous System → Sympathetic System
39
What system causes bronchoconstriction?
Autonomic Nervous System → Parasympathetic System
40
What is **Tachypnea**? How many breaths/min? What does its breathing pattern look like?
Increased rate with normal rhythm \> 20 breaths/min
42
Air will go where gravity pulls it. If you are seated, where will air sit in the lungs?
Bases of the Lung
43
Obstructive Sleep Apnea can happen in anyone but, it is most common in what gender?
Male
44
What are the respiratory control mechanisms during disease like emphysema, chronic bronchitis, pneumonia?
* With pathology: O2 levels drop while CO2 levels remain the same * peripheral chemoreceptors fire in response to low O2 levels * \*\*Be careful giving these patients supplemental O2 - prolonged CO2 retainers learn to tolerate high CO2 levels\*\*
45
What does ventilation/perfusion mismatching create?
Physiological dead space
45
What is **Cheyne-Stokes breathing**? What does its breathing pattern look like?
Gradual increase in rate and depth of breathing, then slower with alternate periods of apnea (may last up to 30 seconds)
46
What do the Aortic and Carotid bodies (peripheral chemoreceptors) respond to? ## Footnote **Ex Phys Notes**
* Primarily: high potassium and dec O2 below partial pressure of 60 mmHg * Not usually significant: inc CO2 and dec H+
47
What 2 things make up the afferent neural input in the respiratory center? *Ex Phys Notes*
1. Muscle and Joints 2. Heart
49
What does firing of peripheral chemoreceptors cause? ## Footnote **Ex Phys Notes**
An increase in ventilation
50
When does Biot's breathing occur?
Result of increased intracranial pressure (ex: head injury)
51
What is Cheyne-Stokes breathing often a sign of?
Impending death
52
Where is the respiratory center located? *Ex Phys Notes*
The Medulla
52
What are chemoreceptors most important for regulating? *Ex Phys Notes*
Minute-to-minute ventilation
54
What are 5 factors affecting work of breathing?
1. **L**ung compliance 2. **E**lastic Recoil 3. **A**irway resistance 4. **D**ead space 5. **S**urface tension (Alveolar)
55
Breathing at **high** volumes has what affect on air distribution in lungs
All alveoli become less compliant and volume changes are similar
56
What is **apnea?** What does its breathing pattern look like?
No breathing
58
How much anatomical dead space does a person have?
Equal to their body weight in ml (Ex: 150 lb person has 150 ml of dead space)
59
Obstructive Sleep Apnea is most commly present with which diagnoses?
* Obesity * Hypersomnolence * Hypoxemia * Right heart failure * Collapse of throat
60
What is work of breathing (WOB)?
Amount of muscular effort needed for inspiration and expiration
62
In the disribution of pulmonary perfusion, what is blood flow dependent on?
Gravity
63
When is the VRG utilized? *Ex Phys Notes*
Important only for forced exhalation (sends signals to abdominals and internal intercostals)
63
What is **Biot's** breathing? What does its breathing pattern look like?
Faster and deeper respirations with abrupt pause
64
How much of our total oxygen consumption is need for a normal work of breathing?
About 5%
65
When does hyperventilation commonly occur?
With anxiety due to signals from cerebral cortex or limbic system that modify normal reflex breathing
66
What is frog breathing or glossopharyngeal breathing?
Used by person with high SCI to force air into lungs
67
What are Juxtacapillary (J) Receptors?
Responds to increased fluid pressure within capliaries or interstitial space → sends signal via vagus nerve → rapid shallow breathing w/ high respiratory rate
69
Juxtacapillary (J) Receptors trigger in the presenece of what illness?
Pulmonary edema
70
Why does surface tension exist in the lungs?
* Makes the alveoli resistant to an increase in size * This and elastic recoil help lungs return to original shape
71
What are the respiratory control mechanisms during **Submaximal** exercise? *Ex Phys Notes*
* Primary drive originates from higher brain centers * chemoreceptors and muscle afferents to "fine-tune" breathing to regulate blood PCO2 levels
73
Where is the Pneumotaxic Center located? *Ex Phys Notes*
Upper portion of the pons
74
In pulmonary perfusion, what is zone 3?
* Most gravty dependent * Receives basically all blood flow
75
Where in the Hering-Breuer Reflex located?
Smooth muscle airways from trachea to bronchioles
77
What are the respiratory control mechanisms during **Maximal** exercise? *Ex Phys Notes*
1. H+: inc in blood levels proportional to inc in ventilation 2. K+: inc in blood levels proportional to inc in ventilation 3. Muscle afferents: inc from inc motor unit recruitment 4. Inc Temp 5. Inc blood catecholamine levels
78
What type of sleep apnea might explain sudden infant death syndrome?
Central sleep apnea
79
What is **Hyperventilation?** What does its breathing pattern look like?
Increased rate or depth
80
What usally causes Cheyne-Stokes breathing?
SLow blood flow between the heart and brain or a change in the feedback sensitivity to CSF [H+] (slow, inefficient blood profusion)
81
Where are the Central Chemoreceptors located? *Ex Phys Notes*
Just under the ventral surface of the medulla
82
What is Obstructive Sleep Apnea?
* Results from collapse or closure of the pharynx, glottis or larynx * Snore when on back - become so relaxed that adipose tissue pushes on airway
83
How do the peripheral chemoreceptors send signals to the respiratory centers? *Ex Phys Notes*
Aortic bodies → Vagus Nerve Carotid bodies → Glossopharyngeal Nerve
84
Where are the Juxtacapillary (J) Receptors located?
Within the alveolar walls near pulmonary capillaries

Cardio Pulm Units (13 decks)

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