Respiratory Phys

Front 1

___ is the volume inspired or expired with each normal breath

Back 1

Tidal Volume

Front 2

____ is the volume that can be inspired over and above the tidal volume.
When is this volume used?

Back 2

Inspiratory Reserve Volume.

It is used during exercise

Front 3

___ is the volume that can be expired after the expiration of a tidal volume

Back 3

Expiratory Reserve Volume

Front 4

____ cannot be measured by spirometry

Back 4

Residual Volume

Front 5

____ is the volume that remains in lungs after a maximal expiration.

Back 5

Residual Volume

Front 6

The static tendency of lungs is to ____, the static tendency of the chest wall is to ____

Back 6

collapse; expand

Front 7

Alveolar Pressure is the sum of:

Back 7

Elastic Recoil Pressure (Pel) plus the pleural pressure (Ppl)

Front 8

Transpulmonary pressure is equal to what

Back 8

(Pl)= Alveolar pressure (PA)-Pleural Pressure (Ppl)

Front 9

What are the two ways to correct a pneumothorax?

Back 9

Add positive pressure to the airways (increase Alveolar pressure), or negative pressure to the intrapleural space.

Front 10

What is the Vital Capacity?

Back 10

Inspiratory Reserve Volume + Tidal Volume + Expiratory Reserve Volume.

It can also be calculated at the Inspiratory Capacity + Expiratory Reserve Volume

Front 11

How can you calculate the total lung capacity (TLC)

Back 11

Vital Capacity + Residual Volume

or...

Inspiratory Capacity + Functional Residual Capacity

Front 12

___ is the maximum volume of gas that can be exchanged in a single breath       

Back 12

Vital Capacity (VC)

This is the IRV + TV + ERV

Front 13

______ is the maximum volume of gas that the lungs (and airways) can contain   

Back 13

Total Lung Capacity (TLC)

*This can NOT be measured with a spirometry

Front 14

_______ is the volume of gas remaining in the lungs (and airways) at the end of a normal exhalation

Back 14

Functional Residual Capacity (FRC):

This is the Expiratory Reserve Volume + the Residual Volume, and therefore can NOT be measured

Front 15

__________ is the volume between the end of exhalation of a tidal breath and the total lung capacity

Back 15

Inspiratory capacity (IC):

Front 16

Inspiratory capacity (IC):

Back 16

is the volume between the end of exhalation of a tidal breath and the total lung capacity

Front 17

Vital Capacity (VC):

Back 17

is the maximum volume of gas that can be exchanged in a single breath

Is the ERV+TV+IRV

Front 18

Functional Residual Capacity:

Back 18

Is the sum of Expiratory Reserve Volume and Residual Volume, meaning it is what is left in the lungs after a normal expiration.

CanNOT be measured

Front 19

A patient with obstructive lung disease such as emphysema or asthma will have what lung values change?

Back 19

They will have an increased residual volume.

Front 20

A patient with restrictive lung disease, such as pulmonary fibrosis will have what change in lung volumes?

Back 20

decrease in TLC (total lung capacity)

Front 21

Compliance (C) is a measure of the _____

Back 21

elastic properties.

Compliance is defined as change in lung volume resulting from a change in distending pressure with units of mL/cm H2O: C = ∆V/∆P

Front 22

What is the equation for respiratory system compliance?

Back 22

1/CRS = 1/CL + 1/CW

Front 23

Regarding the compliance curve: at low volumes lungs distend ___, at higher volumes ______

Back 23

easily,

even large increase in trans-pulmonary pressure produce only small changes in volume

Front 24

The different curves of compliance regarding inspiration and expiration is called _____

Back 24

hysteresis

Front 25

(T/F) Compliance of the lung-chest wall system is less than that of the lungs alone or the chest wall alone.

Back 25

True!

Front 26

What are factors that would shift the oxyhemoglobin curve to the right?

Back 26

Increase H, decrease pH, Increase CO2, Increase Temp, Increase 2,3 DPG (hyperthyroidism, anemia, high altitude, congenital heart disease).

Front 27

In emphysema, the lung is (more/less) compliant. Why?

Back 27

More compliant,

due to destruction of elastic tissue and alveoli.

Front 28

In pulmonary fibrosis the lung is _____ due to _____

Back 28

non compliant

proliferation of connective tissue

Front 29

Why does hysteresis exist?

Back 29

because a greater pressure difference is required to override elastic recoil forces and open a previously closed airway than to keep and already open airway from closing

Front 30

What Two factors contribute to elastic recoil forces?

Back 30

Connective tissue of the lung (elastin and collagen)

Surface tension

Front 31

What is LaPlace's law?

Back 31

net pressure in a gas filled sphere is dependent on the surrounding surface tension and radius of the sphere P = 2T/r

Front 32

Surfactant is secreted by ____ cells and is composed of what?

Physiologically, what is it's effect?

Back 32

Alveolar Type II cells

Mostly DPPC (phosphatidylcholine) and then phosphatidyglycerol

It increases lung compliance

Front 33

In a patient with emphysema, lung compliance is ___ and the tendency of the lungs to collapse is ____.

Therefore, the FRC will be ___

Back 33

increased

decreased

higher. This will make the chests lungs "barrel shaped"

Front 34

In a patient with fibrosis, lung compliance is ____, and the tendency of the lungs to collapse is ___. The lung, chest wall system will seek a ___ FRC.

Back 34

decreased
increased

lower

Front 35

Explain what surfactant does in terms of Laplaces law.

Back 35

Laplaces Law describes the collapsing pressure of an alveolus; P=2T/r.
Therefore, a smaller radius will have a higher collapsing pressure and will collapse easier.
Surfactant reduces T (surface tension), to make P smaller, and less likely for those alveoli to collapse.

Front 36

The ratio of what two substances is used to tell if a fetus has mature levels of surfactant?

Back 36

A 2:1 ratio of lecithin:sphingomyelin.

Front 37

What is atelectasis?

Back 37

Lungs collapsing

Front 38

Sympathetic stimulation (dilates/constricts) airways via __ receptors

Back 38

dilates
Beta2

Front 39

In Obstructive diseases, airway resistance is (increased/decreased)

Back 39

increased.

Patients with these learn to expire slowly with 'pursed lips' to prevent airway collapse that may occur with a forced expiration (bc intrapleural pressure is positive).

Front 40

Asthma is (restrictive/obstructive), and is characterized by (increased/decreased) FVC, (increased/decreased) FEV, and (increased/decreased) FEV/FVC.

Back 40

obstructive
decreased
decreased
decreased

Air that should have been expired is not, leading to air trapping and increased FRC

Front 41

COPD is characterized by (increased/decreased) compliance, (increased/decreased) FVC, (increased/decreased)FEV, and (increased/decreased) FEV/FVC.

Back 41

increased
decreased
decreased
decreased

Front 42

Pink Puffers are patients with ____, and have ___ O2, and _ CO2.

Back 42

COPD, primarily emphysema
less than normal (mild hypoxemia)
normal CO2

Front 43

Blue Bloaters have __ O2, and _ CO2. These are patients with what disorder?

Back 43

much less O2 (severe hypoxemia), increased CO2 (hypercapnia).
COPD, primarily bronchitis

Front 44

Patients with bronchitis can have what other complications?

Back 44

right ventricular failure and systemic edema

Front 45

At what PO2 is hemoglobin 75% saturated?
50% saturate?

Back 45

40 mmHg

25 mmHg

Front 46

Shifts to the right in an oxyhemoglobin curve are caused by what?

Back 46

Increase CO2, decrease pH, Increase Temperature, Increase 2,3 DPG
(think exercise and altitude)
This facilitates the unloading of O2 from hemoglobin

Front 47

Shifts to the left in an oxyhemoglobin curve are caused by what?

Back 47

Decreased PCO2, increase pH, decrease temperature, decrease 2,3 DPG.

This increases the affinity of hemoglobin for O2

Front 48

CO causes a shift in what direction for a oxyhemoglobin curve?i

Back 48

To the left.

This increases the affinity of hemoglobin to O2. Although CO has a much higher affinity for hemoglobin than O2, by binding it, the other 3 sites become readily available to pick up O2.

Front 49

How does living at a higher altitude shift the oxyhemoglobin curve to the right?

Back 49

People who live at High Altitude have chronic hypoxemia, their bodies will produce more 2,3 DPG which will bind to the beta subunit in hemoglobin, decreasing its affinity for O2. This will increase unloading of O2 in the tissues.

Front 50

HbF has a (higher/lower) affinity for oxygen. Explain this using 2,3 DPG

Back 50

higher (ie. shift the curve to the left). HbF has a gamma su instead of beta, therefore it does not bind 2,3 DPG (which binds beta).
This will increase affinity for oxygen.

Front 51

In RBCs, H+ is buffered by ____

Back 51

deoxyhemoglobin.

Front 52

Rate Alveolar pressure, arterial pressure, and venous pressure in Zone 1.

Back 52

Zone one is the apex of the lung, where blood flow is lowest, therefore...

Alveolar Pressure > arterial pressure > venous pressure

Front 53

Rate Alveolar pressure, arterial pressure, and venous pressure in Zone 2

Back 53

Arterial Pressure > Alveolar Pressure > venous pressure

Front 54

Rate Alveolar pressure, arterial pressure, and venous pressure in Zone 3

Back 54

Zone 3 is at the base of the lung, where blood flow is highest

Arterial Pressure > Venous Pressure > Alveolar Pressure

Front 55

In Zone 2, blood flow is driven by the difference between _ pressure and _ pressure

Back 55

arterial and alveolar

Front 56

In the lungs, hypoxia causes ___

Back 56

vasoconstriction

Front 57

Right to left shunts are seen in what condition?

They result in a ___ in arterial PO2

Back 57

Tetralogy of Fallot

decrease

Front 58

A patent ductus arteriosus is an example of what type of shunt?

Does this decrease PO2?

Back 58

left to right
These shunts do not result in a decrease in PO2

Front 59

What is the normal V/Q ratio?

Back 59

.8

Front 60

The V/Q ratio in Zone 1 (apex) is (increased/decreased) compared to that in Zone 3

Back 60

increased

Front 61

In an airway obstruction, the V/Q ratio is ___, the PO2 and PCO2 of capillary blood will approach what values?

Back 61

0

They will approach their values in mixed venous blood.

Front 62

If blood flow is completely blocked (as in a pulmonary embolism), the V/Q is __, and PO2 and PCO2 of alveolar gas will approach what values?

Back 62

Infinity

Their values in inspired air

Front 63

The medullary respiratory center is located in the ___

Back 63

reticular formation

Front 64

Dorsal respiratory group is responsible for ___. Input comes from _ nerves and output is via _ nerve.

Back 64

inspiration

vagus and glossopharyngeal nerves

phrenic

Front 65

Ventral respiratory group is responsible for ___

Back 65

expiration and inspiration

Front 66

The apneustic center is located in the ___. What does it do?

Back 66

lower pons
stimulates long and prolonged gasp (inspiration)...this is called apneusis.

Front 67

The pneumotaxic center is found in the __. What are its actions?

Back 67

Upper Pons
Inhibits inspiration (therefore regulates respiratory rate)

Front 68

Central chemoreceptors in the medulla are sensitive to the _ in the CSF.

Back 68

pH

H+ does not cross the BBB but CO2 does. CO2 crosses, combines with H2O to form H+ and HCO3-. The resulting increase in H+ acts on chemoreceptors and ultimately will cause hyperventilation

Front 69

Peripheral chemoreceptors can be stimulated in a variety of ways. What are they?

Back 69

Decreases in O2 (below 60 mmHg)
Increases in arterial CO2 (less important than central chemoreceptors), increases in arterial H+ independent of CO2 (metabolic acidosis).

Front 70

What is the Hering Breuer reflex?

Back 70

When lung stretch receptors are stimulated by distention of the lungs, they produce a reflex decrease in breathing frequency

Front 71

J receptor are located ___.
How can these receptors be stimulated, and what will it cause?

Back 71

In alveolar walls, close to capillaries.
They can be stimulated by engorgement of the capillaries, as in left heart failure. It will cause rapid, shallow breathing.

Front 72

Joint and muscle receptors are involved in what?

Back 72

Early stimulation of breathing during exercise.

Front 73

The mean arterial PO2 and PCO2 (do/do not) change during exercise
The mean venous PCO2 (do/does not) change during exercise

Back 73

do not

do..it increases

Front 74

What happens to physiological dead space during exercise? Why does this happen?

Back 74

Decreases

The distribution of V/Q ratios becomes more even, therefore decreasing the physiological dead space

Front 75

Respiratory alkalosis can be treated by administering __

Back 75

acetazolamide

Front 76

How does high altitude cause hypertrophy of the right ventricle?

Back 76

Chronic Hypoxemia causes vasoconstriction in the pulmonary circulation, thereby increasing pulmonary arterial pressure. The increase in pressure increases the work of the right side of the heart...leading to hypertrophy

Front 77

_ and _ help prevent the collapse of an alveoli

Back 77

Alveolar Interdependence and Surfactant

Front 78

During inspiration, how does intrapleural pressure change?

Back 78

It gets more negative (from ~-5 cm H20 to ~-7.5 cm H2O)

Front 79

What units do you measure total lung capacity?

Back 79

L/cm H20

Front 80

Individual resistance to airflow in one small airway is _______ than total resistance in small airways.

Back 80

greater

Front 81

During normal breathing, intrapleural pressure is (more/less) negative at the beginning of exhalation

Back 81

More negative at the beginning of exhalation

Front 82

Intrapleural pressure becomes positive during ___

Back 82

forced maximal exhalation

Front 83

What determines gas flow during normal exhalation?

What determines gas flow during forced exhalation?

Back 83

lung elastic recoil pressure

Lung elastic recoil pressure and pleural pressure

Front 84

Airway resistance is ______ during forced exhalation than during maximal inhalation

Back 84

higher

Front 85

Which explains expiratory flow limitations?
a. Positive pleural pressure
b. Positive trans-airway pressure
c. Negative trans-airway pressure
d. Negative intrapleural pressure
e. Low intra-airway pressure

Back 85

C negative trans airway pressure

Front 86

RV =

Back 86

FRC - ERV

Front 87

Compare the FVC and “slow” VC (SVC) in healthy patients

Back 87

FVC > SVC

Front 88

Compare the FVC and “slow” VC (SVC) in patients with increased airflow resistance (ex. COPD).

Back 88

FVC < SVC

Front 89

An increase in PACO2 causes broncho(dilation/constriction) and vaso(dilation/constriction).

Back 89

bronchodilation
vasoconstriction

Front 90

How would you describe the breathing of a patient with restrictive pulmonary disease?

Back 90

rapid and shallow

Front 91

16. Patients with restrictive pulmonary disease have ______ τ.

Back 91

low

Front 92

What is an important diagnostic feature of an anatomic shunt?

Back 92

No change ins PaO2 in response to 100% O2.

Front 93

How does alveolar pressure at the base of the lungs change from a standing to a supine position?

Back 93

It doesn't, it stays the same.

Front 94

What is the PaO2 value that marks hypoxemia?

Back 94

70 mmHg...according to ioudinas slides

Front 95

A patient has pH= 7.2, PaCO2= 60 mmHg, HCO3= 48 mEq/L...how would you describe his condition?

Back 95

respiratory acidosis

Front 96

Regarding airflow in the airways, the trachea and larger airways have more (turbulent/laminar) flow, whereas the smaller airways have more (turbulent/laminar) flow.

Back 96

turbulent

laminar

Front 97

Airway resistance (increases/decreases) with increasing lung volumes.

Back 97

Decreases

Front 98

What are some examples of neurohumoral airway constrictors?

Back 98

PANS, Ach, Histamine, Leukotrienes, Thromboxane A2, Serotonin, decreased PCO2 in small airways

Front 99

What are some examples of neurohumoral airway dilators?

Back 99

SANS (via beta 2), beta2 adrenergic agonists, NO, Increased CO2 in small airways, decreased O2 in small airways

Front 100

What are the most common causes of increased airway resistance?

Back 100

swelling of bronchial wall (edema), obstruction, bronchospasm

Front 101

Normally, Dynamic Compliance is (<,>,=) that Static Compliance.

During exercise, Dynamic Compliance is (<,>,=) that Static Compliance

During shallow and rapid breathing, Dynamic Compliance is (<,>,=) that Static Compliance .

Back 101

< or =

>

<

Front 102

Work of breathing is mostly __, secondary is __ work.

Back 102

elastic work ( ~65%)

resistive work (resistance to airflow and then viscous resistance)

Front 103

Subjects tend to adopt a respiratory rate that ____

Back 103

minimizes the total work of breathing

Front 104

What technique allows you to measure FRC?

Back 104

Inert gas dilution and nitrogen washout technique.

Start at FRC, breath in closed system until helium concentration reaches a plateau. Use V1C1 = (V1 + Vfrc) C2

Front 105

What is the normal airway resistance (Raw)?

Back 105

1 - 3 cmH2O/L sec

Front 106

FVC is measured directly from a ___

Back 106

spirogram

Front 107

What is the forced vital capacity?

What is Forced Expiratory Volume?

Back 107

total air that is exhaled during a forced exhalation

Volume expired in 1 sec

Front 108

Crackles heard in auscultation are indicative of __

Back 108

obstructive pulmonary disease

These sounds are produced by the opening of airways that closed on the previous breath

Front 109

In obstructive diseases, maximal expiration begins and ends at (higher/lower) lung volumes and (higher/lower) flow rates than normal.

Back 109

Higher

Lower

Front 110

In restrictive disease, the lung volumes and flow rates are (increased/reduced) but the flow in relation to lung volume is (higher/lower) than normal.

Back 110

reduced

higher

Front 111

Broncho____ is due to edema, infiltration, hypertrophy of bronchial wall.

Back 111

obstruction

Front 112

Broncho___ is due to contraction of bronchial smooth muscle, as in asthma

Back 112

constriction

Front 113

Bronchial arteries carry (oxygenated/deoxygenated) blood

Back 113

Oxygenated. They carry blood to supporting tissues of the lung

Front 114

An increase in arterial pressure results in a___ in resistance and an ___ in blood flow

Back 114

decrease
increase

Front 115

__ and __ allow for the maintenance of low pulmonary vascular resistance in the face of increased pressure

Back 115

Distention and recruitment

Front 116

What are factors that help keep alveoli 'dry'?

Back 116

Tight junctions between alveolar epithelial cells (type I and type II)
Negative pressure in the lymphatic vessels
Surfactant

Front 117

What are the major causes of pulmonary edema?

Back 117

Lung inflammation reaches pulmonary capillary membranes and causes leakage of plasma protein into interstitial space and alveoli

Left heart failure (increase pulmonary venous pressure)

Front 118

(T/F) Ventilation is evenly distributed in the lungs.

What are the reasons for this?

Back 118

False.

Regional differences are due to gravity (for healthy people), and a variability of airway resistance and compliance (can be significant in OPD pts)

Front 119

Patients with obstructive pulmonary diseases breath _ and _. Explain this using the time constant.

Back 119

Slowly and Deeply

Time Constant t = R x C . Alveolar units with long time constants fill and empty slowly. COPD patients have increases compliance