Respiratory Physiology

Front 1

Conducting zone

Back 1

warms, humidifies, filters aird = Anatomic dead space

Trachea
bronchi
bronchioles
terminal bronchioles

Front 2

Clara Cells

Back 2

stem cells for the ciliated cells
- they are themselves nonciliated
- secrete component of surfactant
degrade toxins
- act as reserve cells

Front 3

Respiratory zone

Back 3

respiratory bronchioles
alveolar ducts
alveoli

Front 4

cartilage is present in

Back 4

Tranchea
Bronchi

Front 5

Pseustratified ciliated columnar cells extend to

Back 5

Respiratory bronchioles
- Macrophages clear debris in the alveoli

Front 6

Goblet cells extend to?

Back 6

the bronchi

Front 7

Smooth muscle extends to?

Back 7

alveolar ducts

Front 8

what tells you if a baby's lungs are mature

Back 8

lecthin: sphingomyelin ration > 2 in amniotic fluid

Lecthin = phosphatidylcholine

Front 9

highest resistance?

Back 9

medium sized bronchi
- Parasympathetic = constricts airway
- sympathetic = dilates airway

Front 10

High Lung Volume

Low Lung Volume

Back 10

High lung volume = Greater Traction & dec resistance

Low Lung volume = less traction & increased resistance

Front 11

Bronchial arteries

Back 11

- dual blood supply

- branch off the aorta

Front 12

Bronchopulmonary segment

Back 12

- tertiary/segmental bronchus
- 2 arteries (bronchial and pulmonary) in the center
- Veins and lymphatics drain along the borders

Front 13

Relation of the pulmonary artery to the bronchus at each lung hilus is described by:

Back 13

RALS

Right = Anterior;
Pulmonary artery is anterior to the bronchus

Left = superior
Pulmonary artery is superior to the bronchus

Front 14

the borders of the pleura are as follows

Back 14

Midclavicular = 7th rib

Mid Axillary = 10th rib

Para veretebral line = 12 th rib

LOWER BORDER OF LUNG IS 2 INTERCOSTALS spaces above the pleura

Front 15

Level of the following structures
Kidney

Spleen

LIver

Back 15

Kidney = 12th rib

Spleen = 9,10,11 th rib

Liver = 8-11 th rib

Front 16

Pain from diaphragm reffered to?

Back 16

shoulder

Front 17

quiet breathing
- Inspiratoin
- Expiration

Back 17

Inspiration - diaphragm

Expiration - passive

Front 18

Exercise
- inspiration
- Expiration

Back 18

Inspiration = EXTERNAL INTERCOSTALS; SCALENE, STERNOCLEIDOMASTOID

Expiration = abdominals and INTERNAL INTERCOSTALS

Front 19

Kallikrein?

Back 19

- activates bradykinin

Front 20

Collapsing pressure?

Back 20

2 x (Surface tension)/ radius

Front 21

Transmural pressure

Back 21

Palveolar - Pintrapleural

intrapleural pressure is always negative during passive breathing
- Intrapleural pressure is positive on forced expiratoin

Front 22

Alveolar pressure

Compliance

Back 22

Negative = lungs expand
Positive = lung collapse

Compliance is slope (dv/dp)
- emphysema = inc compliance = inc slope = New FRC established at higher lung volume

- Fibrosis = dec. compliance & inc elastance = dec slope = new FRC established at lower lung volume

Front 23

FRC

Back 23

- volume in lungs after normal expiration = ERV + RV
- inward pull of lung and outward pull of chest wall are balanced

Front 24

states where compliance is decreased

Back 24

- Pulmonary fibrosis

- insufficient surfactant

- pulmonary edema

Front 25

Taut

&

Relaxed

Back 25

Taut = low affinity for O2

Relaxed = high affinity for O2

- Hgb has positive cooperativity and negative allostery = sigmoid curve

Front 26

Factors that favor Taut form

Back 26

- SHIFT CURVE TO THE RIGHT
- Inc Chloride

- Inc. H+

- CO2

- 2,3 - BPG

Front 27

Nitroprusside

Nitrite

Back 27

Nitroprusside = can cause CN- poisoning

Nitrites = methmeoglobin

Front 28

Bohr effect

Haldane

Back 28

- dec pH causes O2 unloading

- inc pH causes O2 loading

Front 29

Altitude

Back 29

Right-shifts curve favoring unloading

Front 30

Perfusion limited exchange

Back 30

- gas equilibrates early
- diffusion increases only w/ increased blood flow

- O2 (normal health), CO2, N2O

Front 31

Diffusion limited exchange

Back 31

- gast does not equilibrate by the time blood reaches the end of the capillary

- O2 (emphysema and fibrosis); CO

Front 32

Normal Pulmonary artery pressure

Back 32

10-14 mm Hg

Front 33

Bosentan

Back 33

- competitive antagonist of endothelin receptors

- tx pulmonary HTN

Front 34

primary pulmonary HTN

Back 34

- AD
- mutation in TGF-beta
- inactivation mutation in BMPR2 gene (normaly inhibts vascular smooth muscle proliferation)

Front 35

secondary pulmonary HTN

Back 35

- any hypoxic vasoconstriction (COPD)
- Accentuated P2; left parasternal heave

Pressure = Q x R
- COPD (destruction of lung parenchyma)
- mitral stenosis (inc pressure backup)
- recurrent thromboemboli (dec cross-sect area - inc R)
- autoimmune disease
- L-> R shung (endothelial injury due to inc Q)
- Sleep apnea or living at high altitude

Front 36

Course of Pulmonary HTN

Back 36

- severe respiratory distress ->
- cyanosis and RVH ->
- Death from decompensated cor pulmonale

Front 37

Hypoxemia

Back 37

Dec PaO2

- High altitude & Hypoventilation = normal A-a gradient
- V/Q mismatch, Diffusion limitation, R->L shunt = inc A-a gradient

Front 38

Hypoxia

Back 38

- dec O2 delivery to tissue = C.O x O2 Content of blood

- dec C.O
- Hypoxemia (dec PaO2)
- Anemia (dec Hgb)
- CN = dec SaO2 but normal PaO2
- CO = dec SaO2 but normal PaO2

Front 39

Chloride shift

Back 39

- CO2 can be bound to N-terminus of globin as carbaminohemoglobin (5%)
- dissolve CO2 5%

- Bicarbonate (90%)
- exchange of HCO3 for Cl-
- Since more CO2 in veins -> increase HCO3- in RBCs and increase exchange of Cl- and HCO3- in veins

Front 40

Response to high altitude

Back 40

1.) acute inc in ventilation = resp. ALkalosis
2.) Chronic inc in ventilation
3.) inc EPO -> inc HCT and Hgb
4.) Inc 2,3-BPG (Right shifts the curve)
5.) Inc Mitochondria
6.) inc renal excretion of bicarb to compensate for Resp. ALkalosis = can aid w/ acetazolamide
7.) CHronic hypoxic pulmonary vasoconstriction results in RVH