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71 Cards in this Set

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What are the two categories of functions of the lungs?
1. Non-respiratory
2. Respiratory
What are the non-respiratory functions of the lungs?
Chemical release and breakdown of histamine.
What are the 5 respiratory functions of the lungs?
1. Ventilation
2. Respiration
3. Vasoconstriction and dilation for BP
4. Filter Emboli
5. Vocalization
What is ventilation? What is respiration?
Ventilation: Gas TRANSPORT in/out of lungs.

Respiration: Gas EXCHANGE
What does the term Pulmonary refer to?
Lungs, their airways and their vascular system.
What is the relevance of PT's addressing the cardiopulmonary systems in managing all patients.
O2 transport is perturbed by mvmt and activity, changes in body position and emotional stress. If the cardiopulmonary system is disrupted or threatened, it is always a medical priority and Cardiopulm PT is an essential, non-invasive medical intervention that can reverse insults to oxygen transport system.
What do the upper airways consist of? (4) What is their functional significance?
Components: Nose, mouth, pharynx, larynx

Function: Cleanse, heat and humidify air, provide resonance for phonation
What is the functional significance of cilia?
Mobilizes secretions upward. Smoking paralyzes cilia.
What do the lower airways consist of? (5) What is the functional significance of the lower airways?
Components: vocal folds, glottis, trachea, main stem bronchi, alveoli.

Function:
-Vocal folds protect opening of lower airway. Prevent large objects from entering airway.
-Glottis is the potential space btwn and around the folds.
-Main Stem Bronchi (Right has upper, middle, lower lobes. Left has upper and lower lobes)
-Trachea provides cartilaginous support to keep large open airway.
How many times does the conducting airways divide to reach the level of the alveoli?
23 times
What is the function of surfactant? What type of alveolar cells is it made out of?
Necessary for normal respiration, LOWERS surface tension in the lung. A phospholipid that is made from type II alveolar cells
Which side of the lung provides more ventilation? Which side is more likely to aspirate?
Right side = 55%, left side = 45%. Right side is more likely to aspirate due to it's verticle orientation and larger size.
Describe the skeleton of the thorax in relation to stability and mobility.
The skeleton of the thorax is designed for mobility at the expense of stability.
What ribs insert into the sternum? Which do not?
1-6 insert into the sternum. 7-10 have costal cartilage. 11 and 12 do not insert into the sternum at all.
What is happening pulmonary wise at the level of the sternal angle? Rib wise?
Where the R/L bronchiobifrication occur, where bifurcation of trachea into mainstream bronchi. Also where 2nd rib is.
What is the difference btwn upper and lower ribs in regards to mobility?
Ribs 8-10 have much more flexibility for breathing.
Where does the upper lobe end and the middle lobe begin?
3rd or 4th rib
What is the lungs relationship to the clavicle?
Upper lobe of the lung extends to 2.5cm above the level of the clavicle.
Where does the middle lobe of the lung end?
6th rib
What is the bony landmark for the diaphragm?
Base of the rib cage, xiphoid process
Posteriorly, what is the landmark for the division of the lungs?
T2
What is the equivalent on the L side to the middle lobe on the R side?
The lingular division on the L lung is equivalent to the middle lobe of the R lung.
Posteriorly what bony landmark divides the upper lobe from the lower lobes?
Spine of the scapula
Posteriorly what is the bony landmark for the inferior border of the lower lobe of the lungs?
10th rib
Potential mobility is increased as you move in what 2 directions on the rib cage?
INFERIORLY and ANTERIORLY
Where is the most potential mobility? Give bony landmarks.
Xiphoid process and inferior borders of the anterior and lateral ribs.
What makes up the "triad" of normal ventilation?
Diaphragm, Intercostals and abdominals.
What is the innervation of the diaphragm? Planes of mvmt? % of TV effort/volume?
Phrenic N., C3,4,5

Moves in all 3 planes

Provides 2/3 to 3/4 of TV effort and volume.
What is the relationship of the diaphragm with the abdominals and intercostals?
Depends on intercostal and abdominals to help generate adequate pressure changes btwn thoracic (neg.) and abd (pos.) cavities during inhalation.
What kind of pressure does the diaphragm use?
Uses positive pressure of abdominal cavity to stabilize central tendon. Intact abdominals give the central tendon something to pull against.
What are the attachments to the diaphragm?
Soft tissues, ribs laterally and spine posteriorly.
What is the diaphragm doing during quiet and forceful inspiration?
Concentrically contracting.
What is the diaphragm doing during controlled exhalation and speech?
Eccentric contraction. Very good with singers and instrument players.
-What is the innervation of the intercostals?
-What is their primary function? via what?
-What are they doing during exhalation and speech?
-Innervation is T1-T12
-Primary function is to stabilize the rib cage during inhalation, via isometric contraction.
-Eccentric control for exhalation and speech.
What is the result if you have a lack of intercostals?
Paradoxial Breathing
-What is the innervation of the abdominals?
-Function? (4)
Innervated by T6-L1

Functions:
1. Stabilizes inferior border of rib cage
2. Visceral support
3. Positive pressure for the diaphragm
4. Provides necessary intrathoracic pressure for an effective cough
What are the four factors that contribute to controlling breathing?
1. CNS
2. Chemoreceptor
3. Other receptors
4. Arterial pH
What are the three areas in the CNS that control breathing?
Respiratory centers are in the brain stem.
1. Respiratory center in the medulla
2. Apneustic Center in Pons
3. Pneumotaxic Center in Pons
What does the respiratory center in the medulla do in regards to respiration?
It's responsible for the rhythmically of breathing. "Not quite normal in character"
What does the apneustic center in the pons do in regards to respiration?
Inspiratory gasp
What does the pneumotaxic center in the pons do in regards to respiration?
Controls respiratory rate and depth. Balances the above centers.
There are two kinds of chemoreceptors that control breathing. Where are each of them located?
1. Central receptors: located in the medulla
2. Peripheral receptors: located in carotid bodies, arch of the aorta
Aside from their locations, how do central and peripheral chemoreceptors differ?
Central receptors are extremely sensitive and efficient at monitoring Co2 within a narrow range (35-45 mmHg).

Peripheral receptors are less sensitive to changes in Co2.
In regards to gases, what is the primary gas that makes you breath and what is secondary?
The primary drive to breath comes from Co2 and the secondary drive is O2.
Other than chemoreceptors to control breathing, what other receptors do we have to help control breathing?
We have cough/gag protective reflexes.
How does arterial pH help control breathing?
If PaCO2 levels get high, resting respirations will increase to "blow off" excess CO2. Internal regulatory control mechanism.
What is lung compliance?
The ease at which the lungs can EXPAND. Lung elasticity.
What happens when you have too much lung compliance or too little?
Too much - can't return to baseline effectively resulting in air trapping (COPD).
Too little - can't expand easily resulting in decreased inspiratory capacity (restrictive disease or neonate w/o surfactant).
What is the interrelationship between lung compliance and the chest wall?
Lung compliance can cause 2 inch changes in chest wall mobility. Chest wall compliance can cause 2 inch changes in the lungs.
What does "Q" stand for?

Dependent on...
Perfusion: the pumping of a fluid through an organ or tissue.

Gravity/position dependent, in sitting/standing, greatest perfusion in the bases of lungs.
What does "V" stand for?
Ventilation: the circulation of gases in the lungs.

Moves into the least resistant opening.
A V/Q mistmatch may be the result of...
Dead space or a shunt.
Diffusion of gases through the alveolar-capillary membrane is affected by what? (3)
1. Concentration gradient: gases will diffuse from areas of high concentration to areas of low concentration.
2. Surface area: amount of alveolar-capillary interface available for gas exchange. i.e. Emphysema decreased surface area available for gas exchange.
3. Thickness of the membrane. i.e. secretions in the alveolar space will impede gas exchange through the membrane.
Oxygen is transported via 2 ways.
1. Oxyhemoglobin 98%
2. Plasma 1-2% where it is then dissolved.
Carbon Dioxide is carried into the lungs in three ways.
1. 10% Dissolved in blood.
2. 25% carried by hemoglobin.
3. 65% as bicarbonate.
What is total lung capacity (TLC)?
The maximum amount of air the lungs can hold when they are fully inflated
What is vital capacity (VC)?
The maximum volume of air that a person can exhale after maximum inhalation. Vital capacity is the maximum amount of air a person can expel from the lungs after first filling the lungs to their maximum extent and then expiring to the maximum extent
What is residual volume (RV)?
The amount of air left in the lungs after VC maneuver.

The amount of air that remains in a person's lungs after fully exhaling.
What is Inspiratory capacity (IC)?
Starting at the end of a normal expiratory effort and then inhaling as deeply as possible.
What is Inspiratory reserve volume? (IRV)
Above normal inspiratory effort, usually indicative of how well they recruit and use their accessory muscles.

Inspiratory reserve volume is amount of air that can be forcibly inspired at the end of normal inspiration; it is the amount of air which can be inpired on top of the tidal volume.
What is Tidal Volume (TV)?
Volume of air in normal quiet breath.
What is the Expiratory Reserve Volume (ERV)?
Starting from the end of a normal exhalation and then exhaling as forcibly as possible. Generally indicative of how well they recruit and use their abdominal and internal intercostal muscles.

Expiratory reserve volume is amount of air that can be forcibly expired at the end of normal expiration. It is the amount of air which can be exhaled on top of the tidal volume.
What is the Functional Residual Capacity (FRC)?
Expiratory reserve volume plus residual volume.
When TLC increases, it is due to what?
An increase in residual volume, not vital capacity.
What is Cardiac Output? Equation?
the volume of blood ejected from the left side of the heart in one minute.
CO = SV x HR
Innervation of erector spinae? Function related to breathing?
T1-S3. Stabilizes thorax posteriorly to allow normal anterior chest wall mvmt to occur.
Innervation of pecs? Function related to breathing?
C5-T1. Provides upper chest ant. and lat. expansion. (Bending over after you run). Assists in expiratory maneuvers if the trunk moves into flexion. Can be a rib cage stabilizer, if intercostals are paralyzed, to prevent pardoxical breathing.
Innervation of serratus anterior? Function related to breathing?
C5-C7. Posterior expansion of rib cage, especially important for brain injury or SCI.
Innervation of scalenes? Function related to breathing?
C3-C8. Superior and anterior expansion of upper chest. Stabilizes chest during inhalation.
Innervation of SCM? Function related to breathing?
C2-C3 and Accessory CN? stabilizes upper chest during inhalation. Same as scalenes.
Innervation of Trapezius? Function related to breathing?
C2-C4 and Accessory CN? Provides superior expansion of the upper chest. Very inefficient.