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Marcus' A&P S24 > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

What does P IP & P PL stand for?

A

Pleural Pressure

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2
Q
  • What does P A stand for?
A

Alveolar pressure

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3
Q
  • What does P EL & P ER stand for?
A

Elastic recoil pressure

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4
Q
  • What does P TP stand for?
A

Transpulmonary pressure

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5
Q
  • What is the normal pleural pressure & when is it measured?
A

-5 cm H2O & measured in between breaths

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6
Q
  • What is the normal P A pressure?
A
  • 0 cm H2O
  • It oscillates between -1(inspiration) & +1(expiration) cm H2O
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7
Q
  • What does P EL refer to & what is its normal pressure?
A
  • It refers to stretched out lung wanting to recoil
  • The pressure is +5 cm H2O (equal & opposite to intrathoracic pressure)
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8
Q
  • What is the formula for Transpulmonary pressure?
A

P TP= P A – P IP

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9
Q
  • What does transmural pressure refer to?
A

Pressure available to fill up the lungs

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10
Q

What does a (+) transmural pressure indicate?

A

Availability to put air into the lungs

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11
Q

What is the chest wall’s normal resting tone?

A

Outward

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12
Q

What do the following letters stand for; C, a, A, V, D?

A
  • C= Content
  • a= arterial
  • A= Alveolar
  • V= Ventilation per min
  • D= Gas absorbed/expired per min
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13
Q

How much oxygen (mg) does 1 dL have?

A

20mg

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14
Q

What is the formula for compliance?

A

Compliance= Delta V / Delta P

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15
Q

What is the formula for Elastance?

A

Elastance= Delta P / Delta V

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16
Q

When is someone’s peak lung function?

A

At age 20

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17
Q

What is the normal VT?

A

500mL

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18
Q

What is the normal FRC?

A

Normal functional residual capacity is 3.0L

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19
Q

What volume or capacity helps keep the lungs from collapse?

A

RV

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20
Q

What makes up the FRC?

A

ERV= 1.5 L & RV= 1.5 L

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21
Q

What is the lung volume at the end of maximal expiration?

A

1.5L only the RV is left

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22
Q

What is used as a buffer when we do not breath for a bit but already exhaled?

A

RV

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23
Q

What is the total lung capacity (TLC)?

A

6.0 L

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24
Q

What makes up Vital capacity (VC)?

A
  • IRV= 2.5 L,
  • VT= 0.5 L
  • ERV= 1.5 L
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25
Q

What is the max IRV?

A

2.5 L

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26
Q

In the supine position, which lung volume(s) do not change?

A

RV, VT

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27
Q

In the supine position, which volume(s) decrease?

A

ERV, FRC

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28
Q

In the supine position, which volume(s) increase?

A

IRV

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29
Q

How long is the normal breathing cycle?

A

5sec total
- Inspiration= 2sec
- expiration= 2sec
- 1 sec in between

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30
Q

What changes does the PA undergo during expiration?

A

PA goes to +1 cm H2O at 1sec then back to 0 @ the end of expiration

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31
Q

What is the P ER at the end of inspiration?

A

-7.5 cm H2O

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32
Q

When is the max inspiratory Delta P for the alveoli?

A

It is @ 1sec of the inspiratory cycle. PA pressure is @ -1 cm H2O

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33
Q

What makes up the PVR?

A

Alveolar & Extraalveolar BV’s

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34
Q

How does lower lung volumes affect PVR?

A

There is a higher increase in Extraalveolar resistance than decrease in Alveolar resistance resulting in a higher PVR

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35
Q

How does higher lung volumes affect PVR?

A

There is a small decrease in Extraalveolar resistance & big increase in Alveolar resistance resulting in a higher PVR.

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36
Q

Does an increase or decrease in lung volume lead to a higher PVR?

A

Decrease

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37
Q

What happens to alveolar capillaries during inspiration?

A

They increase in length & decrease in diameter –> higher resistance

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38
Q

What happens to Extraalveolar vessels during inspiration?

A

The negative pressure pulls on the vessel walls increasing diameter & decreasing resistance.

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39
Q

How much dead space volume is there?

A

150 mL

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40
Q

What is the normal RR?

A

12 bpm

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41
Q

What does V E stand for?

A

Total minute ventilation

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42
Q

What do most pulmonary tests look at?

A

At expired air

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43
Q

What action is the better option to increase O2 saturation?

A

Increase depth of breath rather than RR

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44
Q

What is the formula for calculating tidal volume?

A

VT= VDS + VA

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45
Q

Where is the apex of the lung?

A

It extends superior passed the 1st rib

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46
Q

Where is the most movement of the lungs & how much is it?

A

At the base & it’s about 2cm

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47
Q

What seals the thorax & abdomen?

A

The central tendon

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48
Q

What are the 3 diaphragm openings, anterior to posterior?

A
  • Caval aperture
  • Esophageal aperture
  • aortic aperture
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49
Q

What is the caval aperture?

A

Opening for the inferior vena cava

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50
Q

What nerve is connected to the diaphragm?

A

The L & R phrenic nerves

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51
Q

What prevents inferior thorax movement during inspiration?

A

The scalene muscles

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52
Q

The anterior scalene muscle connects to what structures?

A

The 1st rib & to C3 - C6

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53
Q

The middle scalene muscle connects to what structures?

A

The 1st rib & to C3 – C7

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54
Q

The posterior scalene muscle connects to what structures?

A

The 2nd rib & to C5 – C7

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55
Q

What structures make up the dead space?

A
  • Trachea
  • Bronchi
  • Bronchioles
  • Terminal bronchioles
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56
Q

What structures play part in actual air exchange?

A
  • Respiratory bronchioles
  • alveolar ducts
  • alveolar sacs
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57
Q

How many generations does the conducting zone have?

A

16 generations

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58
Q

How many generations does the respiratory zone have?

A

7 generations
17 - 23

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59
Q

What is stridor?

A

Noise from an obstruction in the airway

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60
Q

What is hyperpnea?

A

Hyperventilation in excess of metabolic needs

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61
Q

What is orthopnea?

A

Body position changes cause difficulty breathing

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62
Q

What is the difference between looking blue & looking grey?

A
  • Blue means the Hgb does not have O2 attached.
  • Grey means Hgb is low.
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63
Q

At what point does cyanosis occur?

A

When Deoxy Hgb is > 5 gm/dL

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64
Q

What is hypoxia?

A

Decreased O2 amount at tissue level

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65
Q

What is hypoxemia?

A

Decreased O2 in arterial blood

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66
Q

What is hyper/hypocapnia?

A

Excessive/deficiency of CO2 in arterial blood

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67
Q

Air passes through the nose or mouth, to the___, and then to the___ and then into the tracheobronchial tree.

A

Pharynx & larynx

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68
Q

What constitutes the transitional zone?

A

Generations 17-19, the respiratory bronchioles

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69
Q

What all entails an acinus?

A

An acinus includes respiratory bronchiole, alveolar ducts & alveolar sacs distal to a single terminal bronchiole

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70
Q

What are the air pathway structures after the larynx to gas exchange?

A

Trachea ->
bronchi ->
bronchioles ->
terminal bronchioles ->
respiratory bronchioles ->
alveolar ducts ->
alveolar sacs

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71
Q

What is the structural difference from bronchi and bronchioles?

A

Bronchioles do not contain cartilage.

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72
Q

Clara cells secrete what?

A
  • Proteins (SpA, B, C & D)
  • lipids
  • glycoproteins
  • inflammatory modulator
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73
Q

What are the other functions of Clara cells?

A
  • Metabolize foreign materials
  • participate in airway fluid balance
  • act as progenitor cells
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74
Q

About how many alveoli are in a healthy human being?

A

~ 480 billion

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75
Q

What allows for interalveolar communications?

A

The pores of Kohn

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76
Q

What is the ratio of Type I to Type II cells?

A

1:2

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77
Q

Type I cells cover about___% of the alveolar surface due to__?

A

90-95% Due to the larger surface area

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78
Q

What are the purposes of Type I cells?

A
  • They allow for easy gas exchange
  • Help remove liquid from the alveolar surface by pumping sodium & water into the interstitium.
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79
Q

What generates spontaneous automatic breathing?

A

Neurons located in the medulla

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80
Q

What causes the resting negative intrathoracic pressure?

A

The mechanical interaction in opposite directions between the lung and chest wall

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81
Q

What is contained in the intrapleural space?

A

About 15-25mL of a serous liquid

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82
Q

During inspiration the transmural pressure difference___ & the alveoli are distended, ___ alveolar pressure?

A

Increases & Decreasing

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83
Q

Alveolar pressure is equal to intrapleural pressure + _____?

A

Alveolar elastic recoil pressure

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84
Q

What establishes the pressure gradient for air flow?

A

Increasing alveolar volume lowers alveolar pressure

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85
Q

What mechanically transmits the pressure difference across alveoli?

A

The alveolar septa

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86
Q

What are the accessory inspiratory muscles & when are they involved?

A
  • The sternocleidmastoid, the trapezius, & vertebral column muscles.
  • They are involved during exercise, coughing, sneezing or pathologic state such as asthma
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87
Q

The diaphragm is considered part of the___?

A

Chest wall

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88
Q

When supine the diaphragm is responsible for ___ of the air entering during eupnea? What about standing?

A
  • Supine is 2/3 &
  • Standing is 1/3
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89
Q

The diaphragm is innervated by the ____, which leave the spinal cord at the __ thru the ___ cervical segments?

A
  • Phrenic nerves
  • 3rd & 5th
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90
Q

What holds the diaphragm to the lower 6 ribs & the sternum?

A

By 2 crura

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91
Q

During eupnea the diaphragm descends __ cm & during deep breathing is descends __ cm?

A

1-2cm & 10cm

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92
Q

The scalene muscles are accessory muscles?

A

False, they contract during eupnea, therefore are not accessory muscles

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93
Q

What muscles contract during normal expiration?

A

None, expiration is passive

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94
Q

In obese people the inspiratory muscle may also contract, when?

A

During early part of expiration

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95
Q

When does active expiration occur?

A

During exercise, speech, signing, sneezing, coughing, bronchitis.

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96
Q

Contraction of the internal intercostal muscles move the ribcage___?

A

Downward, opposite of the external intercostals

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97
Q

What is the I:E ration in eupnea?

A

1:2 or 1:4

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98
Q

During inspiration the alveolar pressures ___?

A

Decrease (-1 cm H2O)

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99
Q

Compliance is the inverse of ____?

A

Elastance

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100
Q

Elastance refers to?

A

Tendency for something to oppose stretch & its ability to return to its original state.

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101
Q

Surfactant has a lesser effect on surface tension during___ due to?

A
  • Inspiration.
  • Due to movement of surfactant from interior of the liquid phase to the surface during inspiration.
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102
Q

Many pathologic states shift the compliance curve to the___?

A

Right ( for any increase in transpulmonary pressure there is less of an increase in lung volume)

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103
Q

Fibrosis, atelectasis & thermal injuries ___ alveolar elastic recoil?

A

Increase. Fibrosis decreases compliance, therefore elastance is increased

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104
Q

Emphysema ___ compliance due to the destruction of the ___ tissue?

A
  • Increases
  • septal tissue, which opposes lung expansion.
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105
Q

Compliance in obese people is ___?

A
  • Decreased.
  • Moving the diaphragm downward is much more difficult
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106
Q

Abdominal distension & scars from burn injuries cause ___ chest wall compliance?

A

Decreased

107
Q

How does someone with emphysema compensate?

A

With a greater RR & smaller Vt

108
Q

Compliance is ___ dependent. When is it lower & greater?

A
  • Volume
  • lower at high volumes & higher at low volume
109
Q

What is the normal compliance of the lung, in L/cm H2O?

A

0.2L/cm H2O

110
Q

When is Elastin more compliant & important?

A

At low or normal lung volumes

111
Q

What is the unit of measure for surface tension?

A

Dyn/cm

112
Q

What is the formula for calculating (T)ension?

A

T= (P x r) / 2

113
Q

Do smaller or larger alveoli have lower surface tension?

A

Smaller

114
Q

Surfactant consists of?

A
  • 85-90% lipids(75% phosphatidylcholine)
  • 10-15% proteins
115
Q

What is the functions of SP-A & SP-D?

A

Host defense

(D) for Defense

116
Q

When does fetal surfactant production begin?

A

Around the fourth month of gestation.

117
Q

What are the functions of surfactant?

A
  • Maintain the stability of small airways
  • Decrease work of inspiration by lowering surface tension –> reducing elastic recoil –> increasing compliance
118
Q

Hypoxia or hypoxemia may lead to?

A

A decrease in surfactant production, inactivation or an increase in surfactant destruction

119
Q

A lack of surfactant can temporarily be overcome by?

A

Ventilating someone with positive pressure (PEEP)

120
Q

A lack of surfactant will lead to?

A

Increased elastic recoil of alveoli & spontaneous atelectasis.

121
Q

What is alveolar interdependence?

A

Alveoli are polygons held open by the chest wall pulling on the outer surface of the lung. If an alveolus stars to collapse the surrounding alveoli will hold it open.

122
Q

What is FRC?

A
  • Volume of gas in the lungs at the end of eupnea.
  • No muscles are actively contracting.
123
Q

When are the elastic recoil & chest wall recoil equal?

A

At FRC

124
Q

At high lung volumes the chest wall recoil pressure is positive or negative?

A

Positive

125
Q

What are the FRC’s, in a healthy person, when standing & supine & at 30degrees?

A
  • Standing= 3L
  • Supine= 2L
  • 30°= 2.5L
126
Q

What kind of airflow is present in the trachea & larger airways?

A

Either turbulent or transitional

127
Q

With what can alveolar pressure be measured?

A

With a body ple/thys/mo/graph

(4 syllable)

128
Q

What is vital capacity?

A

Volume of air one is able to expire after maximal inspiration

129
Q

Describe a FVC (Forced Vital Capacity) test & what is it used for?

A
  • A person max inhales to TLC then gives max effort to exhale. Only the RV is left.
  • It is used as a good index of expiratory airways resistance.
130
Q

Lung volume is measured with a ___ & airflow rate is determined by using a ___?

A

Spirometer & (pneumo)(tacho)(graph)

131
Q

What muscle(s) tighten the vocal folds?

A
  • Cricothyroid muscles
  • Vocalis muscle
132
Q

What muscle(s) adduct the vocal folds?

A
  • Thyroarytenoid muscles
  • Transverse arytenoid muscle
  • Lateral cricoarytenoid muscle
  • (3x arytenoid, + 1x thyro + 1x crico)
133
Q

What muscle(s) abduct the vocal folds?

A

Posterior cricoarytenoid muscles

134
Q

What is the only extrinsic laryngeal muscle?

A

The Cricothyroid muscle

135
Q

Which lobe is the largest & the smallest?

A
  • Largest= Left Superior lobe
  • Smallest= Left inferior lobe
136
Q

What is in-between the thyroid cartilage & the cricoid cartilage?

A

The median cricothyroid ligament

137
Q

Increased interstitial pressure leads to____ PVR due to____?

A
  • Increased
  • due to compression of vessels
138
Q

How does positive pressure ventilation affect alveolar vessels?

A

They are compressed and derecruited

139
Q

What intrapleural vessels are affected by positive pressure ventilation?

A

Extraalveolar & vena cava are compressed

140
Q

What active influences can decrease PVR?

A
  • ACh is #1
  • beta-adrenergic agonists
  • bradykinin
  • nitric oxide
  • PGE1
  • prostacyclin
  • PSNS stimulation

A, B2, N, P3

141
Q

What active influences can increase PVR?

A
  • alveolar hypoxia & hypercapnia
  • angiotensin
  • Alpha adrenergic agonists
  • Epinephrine/Norepinephrine
  • endothelin
  • histamine
  • PGF & PGE2
  • pH (low mixed venous)
  • SNS stimulation
  • thromboxane
142
Q

What is the partial pressure & percentage of atmospheric N2?

A
  • 600.3 mmHg
  • 79%
143
Q

What is the partial pressure & percentage of atmospheric O2?

A
  • 159.0 mmHg
  • 21%
144
Q

What is the partial pressure & percentage of atmospheric CO2?

A

0.3 mmHg & 0.04%

145
Q

Describe perfusion of Zone 1?

A
  • No perfusion during any part of the cardiac cycle.
  • Higher resistance
  • less recruitment
  • lower intravascular pressures.
146
Q

Describe perfusion of Zone 3?

A
  • Perfusion is continuous due to higher pressures.
  • Lower resistance
  • more recruitment & distention.
147
Q

Describe ventilation of Zone 1?

A
  • Alveolar pressure is > arterial pressure, which is > venous pressure.
  • Alveoli are larger
  • less compliant
  • less ventilation.
148
Q

Describe ventilation of Zone 3?

A
  • Arterial pressure is > venous pressure, which is > arteriolar pressure.
  • Smaller transmural pressure gradient.
  • More compliant & smaller alveoli.
149
Q

Describe ventilation of Zone 4?

A

Zone 4 has continuous blood flow but perfusion is a bit lower than Zone 3 due to compression of the lung’s weight.

150
Q

What is the blood flow like in Zone 2?

A

It is more of a pulsatile flow

151
Q

When is PVR at the lowest point?

A

At FRC

152
Q

Increasing lung volume leads to?

A

Decreased extra alveolar resistance & a big increase in alveolar resistance

153
Q

How is resistance affected by decreasing lung volume?

A
  • High increase in extraalveolar resistance
  • slight decreased alveolar resistance
154
Q

How does a cardiac index of 1.5 affect PVR?

A

Low blood flow results in a very high PVR

155
Q

What is the formula for Partial pressure?

A

Pp= total pressure x gas concentration [Pp= 760 mmHg x 0.21 (O2)]

156
Q

What is the humidity level at sea level?

A

Trick question, there is non for our purposes

157
Q

How much O2 is absorbed each breath & per min?

A

1) Calculate inspiration. Use Pio2 of 149 mmHg –> O2= 149 mmHg / 760 mmHg= 19.61%.
2) 350 mL x 19.61%= 68.62 mL
3) Calculate expiration of O2: PO2 is 104 mmHg –> O2= 104 mmHg / 760 mmHg= 13.68%.
4) 350 mL x 13.68%= 47.89 mL.
5) 68.62 mL – 47.89 mL= 20.73 mL O2/breath.
6) 20.73 mL O2/breath x 12 bpm= 248.76 mL O2/min

158
Q

What is the standard PicCO2?

A

0.3 mm Hg

159
Q

What is the standard PiN2?

A

564.0 mm Hg

160
Q

What is the standard Pi H2O?

A

47 mm Hg

161
Q

What is the formula for inspired humidified gas?

A

PiO2= FiO2 (Pb – PH2O)

162
Q

What does PB stand for?

A

Atmospheric pressure

163
Q

How many mL of O2 are absorbed per 1 dL?

A

Around 5 - 6 mL (depending on rounding)

Calculation:
- O2 inhaled per breath= 68.6 mL
- O2 exhaled per breath= 47.6 mL
- 21 mL absorbed per breath
- 21 mL x 12= 252 mL
- Minute ventilation is 4,200 mL
- 4,200 mL dived by 100 (dL)= 42 dL
- 252 mL divided by 42 dL= 6 mL

164
Q

How much CO2 is discarded per 1 dL?

A

4.5 mL

165
Q

CO2 is very ____ but O2 is not?

A

Water soluble

166
Q

What are the values for deoxygenated venous blood & venous CO2?

A

PvO2= 40 mm Hg PvCO2= 45 mm Hg

167
Q

What are the PAO2, PACO2 & PAN2 after equilibration?

A
  • PAO2= 104 mm Hg
  • PACO2= 40 mm Hg
  • PAN2= 569 mm Hg
168
Q

What is the normal Interstitial capillary hydrostatic pressure?

A

– 4 mmHg

Lange gives a range of -5 to -7 mmHg

169
Q

What is the normal interstitial capillary oncotic pressure?

A

~ 8 mm Hg

170
Q

What happens when we have decreased colloids or diluted blood?

A

Extra fluid will accumulate in the lungs

171
Q

What is the Starling Capillary Equation?

A

Qf= [ Kf(Pc – Pis) – 𝞂(πpl – πis) ]

172
Q

What does 𝞂 stand for?

A

Reflection coefficient (ability of membrane to prevent leakage.

173
Q

What does Kf stand for?

A

Capillary filtration coefficient (permeability characteristics of the membrane to fluids)

174
Q

What happens to small blood vessels during inspiration?

A

Their diameter is reduced & increased in length –> increased resistance

175
Q

What happens to extra-alveolar vessels during inspiration?

A

The negative pressure pulls on them –> increased diameter –> decreased resistance.

176
Q

At low lung volumes, alveolar vessel resistance ___?

A

Decreases

177
Q

What is the minimum PAO2 someone can still be healthy at?

A

40 mm Hg

178
Q

What is the formula for Alveolar ventilation?

A

VA= RR x VA (VA per min= 12 x 350 mL)

179
Q

How does increased metabolism affect PAO2 & PCO2?

A
  • PAO2 is reduced
  • PCO2 is increased
180
Q

What happens to alveolar capillaries in responds to elevated CO2?

A

They constrict –> O2 being absorbed but no new air coming in & CO2 will build up.

181
Q

What is HPV?

A
  • Hypoxic pulmonary vasoconstriction.
  • Areas with low perfusion get “constricted” to move fresh air to well perfused areas
182
Q

What & why should someone with HPV not receive?

A
  • Increased inspired O2.
  • This will lead to O2 entering low or none perfused alveoli, which were previously constricted & take air away from functional areas
183
Q

What happens if someone receives 100% FiO2 over several days?

A

Inflammation throughout the lung

184
Q

How do anesthetics affect HPV?

A

All anesthetics knock out the HPV function

185
Q

Squeezing ones’ abdomen results in ____ thoracic pressure?

A

Increased

186
Q

At RV the apex is more/less compliant than the base?

A
  • More.
  • Base is most likely collapsed and increased pressure is needed to recruit them first.
187
Q

Calculate FRC with the following values: Spirometer= 20L + 15% of that is Helium, final He concentration is 14%?

A

1) 20 L x 0.15%= 3L
2) X= 3 L / 0.14% = 21.43 L –> FRC= 1.43 L

188
Q

What should one living in a basement in Michigan test for?

A

Radon (Rn), which is the 2nd leading cause of lung cancer

189
Q

-Emphysema is a/n ___disease due to the ___ of ___.

A
  • Obstructive,
  • Loss & recoil
190
Q

What ventilator mode should not be used in emphysema Pt’s?

A

Positive pressure ventilation –> small airways collapse

191
Q

Fibrosis is a/n ___ disease leading to ___ compliance?

A
  • Restrictive
  • Decreased
192
Q

What is Radon’s atomic number & weight?

A

86 & 222

193
Q

Filling lungs strictly with water results in?

A
  • No surface tension
  • increased compliance
194
Q

Surface tension makes up how much of the recoil tension?

A

2/3

195
Q

Increased surface tension leads to?

A

Increased work to inhale

196
Q

What slows down intrinsic digestion of the lungs?

A

Alpha1 Antitrypsin

197
Q

What is ⍺1 A/T & where is it produced & with what disease is it inhibited?

A
  • It is a antiprotease & is produced in the liver.
  • Inhibited in emphysema
198
Q

What happens to TLC, IC, FRC, VC, IRV, VT, ERV & RV in restrictive diseases?

A

They all are reduced.

199
Q

SP-D & SP-A are ___ & SP-C & SP-B are ____?

A

Hydrophilic & Hydrophobic

200
Q

What are the functions of surfactant’s lipids?

A
  • Lower surface tension
  • change proliferation & cytotoxicity of lymphocytes.
201
Q

What are the functions of surfactant’s proteins?

A
  • Enhance chemotaxis & phagocytosis
  • Aggregation & opsonization of micro-organisms
  • Inhibit the growth of pathogens
202
Q

What is a normal V/Q ratio & how is it calculated?

A
  • 0.8 L/min
  • Calculated by V= 4.2 L/min / Q= 5 L/min
203
Q

Zone 3 has a higher V/Q ration than Zone 1?

A

False, the lower lung has a lower V/Q despite increased perfusion

204
Q

Compare expired PO2 & CO2 of the upper & lower lung?

A
  • Upper lung will have higher PO2 & lower CO2.
  • Lower lung will have lower PO2 & higher CO2
205
Q

An airway obstruction will cause a ___ V/Q ratio?

A

Low (Low ventilation= usually low V/Q ratio)

206
Q

How much lung volume is lost in the supine position?

A

About 1L

207
Q

What happens to TLC, FRC, VC, VT, ERV & RV in obstructive diseases?

A

TLC, FRC, VT & RV are increased. VC & ERV are reduced.

208
Q

Why is the RV important in healthy people?

A

It prevents the lungs from collapsing

209
Q

Explain ERV?

A

Volume of gas expelled during max force. It starts after normal Vt expiration

210
Q

IRV is determined by?

A

Strength of inspiratory muscles, inward elastic recoil of the lung & chest wall

211
Q

What would be a normal reason for FRC to be lower than usual?

A

Exercise

212
Q

When does IC begin?

A

At the end of normal expiration

213
Q

Explain VC?

A
  • Volume of air expelled during max forced expiration.
  • Starts after maximal forced inspiration
214
Q

What happens to the FRC, ERV, IRV, VC, RV & TLC when going from standing to supine?

A
  • FRC decreases due to gravity no longer pulling on diaphragm.
  • VC, RV & TLC do not change significantly but may slightly decrease d/t venous blood collecting in the lower extremities.
  • ERV decreases.
  • IRV increases
215
Q

What lung volumes can be measured with a spirometer?

A

VT
IRV
ERV
IC
VC
FEV1
FVC

216
Q

What lung volumes cannot be determined with a spirometer?

A

RV
FRC
TLC

217
Q

Why is Helium used in PFT?

A

It is not taken up by pulmonary capillary blood & it does not diffuse out of the blood.

218
Q

At what exact moment is the Helium-dilution technique stopped?

A

At the end of normal tidal volume

219
Q

What is a reasonable estimate for anatomic dead space?

A

1 mL of dead space per pound of ideal body weight

220
Q

How much CO2 comes from dead space?

A

Trick question, none

221
Q

When seated which alveolar regions receive more ventilation per unit volume?

A

The lower regions.

222
Q

Where in the lung is most ERV, IRV & IC located?

A
  • ERV= In the upper portions
  • IRV & IC= in the lower regions
223
Q

Explain the air path when starting to inhale from RV?

A

The initial air enters the nondependent upper alveoli then the lower alveoli fill.

224
Q

Where would airway closure most likely happen & why?

A
  • In the lower parts of the lungs.
  • The alveoli are smaller & have less recoil pressure.
225
Q

Kyphoscoliosis is what kind of disease in relation to airway?

A
  • A restrictive disease.
  • It results in decreased compliance of the rib cage with much less outward recoil at low thoracic volumes & much greater inward recoil at higher volumes.
226
Q

Why is the RV important in healthy people?

A

It prevents the lungs from collapsing

227
Q

Explain ERV?

A

Volume of gas expelled during max force. It starts after normal Vt expiration

228
Q

IRV is determined by?

A

Strength of inspiratory muscles, inward elastic recoil of the lung & chest wall

229
Q

What would be a normal reason for FRC to be lower than usual?

A

During exercise

230
Q

When does IC begin?

A

At the end of normal expiration

231
Q

Explain VC?

A

Volume of air expelled during max forced expiration. Starts after maximal forced inspiration

232
Q

What happens to the FRC, ERV, IRV, VC, RV & TLC when going from standing to supine?

A
  • FRC decreases due to gravity no longer pulling on diaphragm.
  • VC, RV & TLC do not change significantly but may slightly decrease d/t venous blood collecting in the lower extremities.
  • ERV decreases
  • IRV increases
233
Q

What lung volumes can be measured with a spirometer?

A

VT, IRV, ERV, IC, VC & FEV1, FVC

234
Q

What lung volumes cannot be determined with a spirometer?

A

RV, FRC & TLC

235
Q

Why is Helium used in PFT?

A
  • It is not taken up by pulmonary capillary blood &
  • it does not diffuse out of the blood.
236
Q

At what exact moment is the Helium-dilution technique stopped?

A

At the end of normal tidal volume

237
Q

What is a reasonable estimate for anatomic dead space?

A

1 mL of dead space per pound of ideal body weight

238
Q

How much CO2 comes from dead space?

A

Trick question, none

239
Q

When seated which alveolar regions receive more ventilation per unit volume?

A

The lower regions.

240
Q

Where in the lung is most ERV, IRV & IC located?

A
  • ERV= In the upper portions IRV &
  • IC= in the lower regions
241
Q

Explain the air path when starting at RV?

A

The initial air enters the nondependent upper alveoli then the lower alveoli fill.

242
Q

Where would airway closure most likely happen & why?

A
  • In the lower parts of the lungs.
  • The alveoli are smaller & have less recoil pressure.
243
Q

Kyphoscoliosis is what kind of disease in relation to airway?

A
  • A restrictive disease.
  • It results in decreased compliance of the rib cage with much less outward recoil at low thoracic volumes & much greater inward recoil at higher volumes.
244
Q

Increasing transmural pressure difference leads to___ vessel diameter & ___ resistance?

A

Increased & Decreased

245
Q

With high lung volumes, resistance to blood flow offered by the alveolar vessels ___?

A

Increases greatly

246
Q

How does positive-pressure ventilation affect alveolar & intrapleural pressures?

A
  • Both pressure will be positive during inspiration.
  • Alveolar & extraalveolar vessels are compressed & resistance to blood flow increases.
247
Q

When would alveolar & intrapleural pressures be positive during inspiration & expiration?

A
  • During positive-pressure ventilation w/ PEEP –> increased PVR & decreased transmural pressure differences.
  • CV reflexes should adjust. If not CO will fall dramatically.
248
Q

How does tripled CO affect PVR?

A

PVR is decreases passively due to recruitment, distention or both

249
Q

Neural effects innervate which pulmonary vessels?

A
  • Larger vessels are innervated more than smaller vessels.
  • No innervation of vessels smaller than 30µm
250
Q

When does perfusion cease?

A

When alveolar pressure is equal to pulmonary artery pressure

251
Q

How does exercise affect Zones 1-3?

A

Zone 1 will turn into Zone 2 & the zone boundaries will move upward

252
Q

How does the CNS control HPV?

A

Trick question, it does not. (Pg 111 in Lange)

253
Q

How is HPV regulated on a cellular level?

A

Hypoxia inhibits an outward K+ current, which causes pulmonary vascular smooth muscle to depolarization, allowing calcium to enter the cells leading to contraction.

The K+ channel is open when oxidized & closed when reduced.

Lange page 111 (Hypoxic HPV)

254
Q

How does alkalosis affect HPV?

A

It can interfere with HPV & open up previously closed areas.

255
Q

How do ARDS, O2 toxicity & inhaled toxins lead to pulmonary edema?

A

Increase capillary permeability (Kf, 𝞂)

256
Q

How do increased LA pressure, MS & too much IVF lead to pulmonary edema?

A

Increase capillary hydrostatic pressure (Pc)

257
Q

How do rapid hemo/pneumothorax evacuation or upper airway obstruction lead to pulmonary edema?

A

Decreasing interstitial hydrostatic pressure (Pis)

258
Q

How do protein starvation, diluted blood proteins & proteinuria lead to pulmonary edema?

A

Decrease the colloid osmotic pressure (πpl)

259
Q

Label # 1 thru 6

A

1) Tubular myelin
2) Type 1 cell
3) Type 2 cell
4) Macrophage
5) Multivesicular bodies
6) Lamellar bodies

260
Q

What is the Bohr’s equation to calculate physiologic dead space?

A

Vd / Vt = (Paco2 - Peco2) / Paco2

Example: Vd / 500 mL = (44 mmHg - 30 mHg) / 44 mmHg
–> Vd = (14 mmHg / 44 mmHg) x 500 mL
–> Vd = 0.318 mmHg x 500 mL
–> Vd = 159.01 mL

261
Q

What is the formula to calculate alveolar oxygen tension?

A

PAO2 = FiO2 (PB - PH2O) - (PaCO2 / R)

Example:
–> PAO2 = 0.70% (760 mmHg - 47 mmHg) - (40 mmHg / 0.8)
–> PAO2 = (0.70% x 711 mmHg) - 50 mmHg
–> PAO2 = 499.1 mmHg - 50 mmHg
–> PAO2 = 449.1 mmHg

262
Q

PiO2 can be substituted with what?

A

PiO2 = FiO2 (PB - PH2O)

263
Q

What is the formula to calculate A-a gradient?

A

PAO2 = PiO2 - ( PaCO2 / R )

PiO2 can be substituted with [ FiO2 x (PB - PH2O) ]

Marcus' A&P S24 (9 decks)

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